Provider Demographics
NPI:1558646182
Name:PETRILLO, KATHERINE A (RN)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:A
Last Name:PETRILLO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 CARROLL DR
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-1823
Mailing Address - Country:US
Mailing Address - Phone:845-986-9766
Mailing Address - Fax:
Practice Address - Street 1:379 MT HOPE RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-7135
Practice Address - Country:US
Practice Address - Phone:845-344-2292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-14
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY335941-1163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics