Provider Demographics
NPI:1629420195
Name:PETRELLA, BRIELLE LYNN (CLC)
Entity Type:Individual
Prefix:MRS
First Name:BRIELLE
Middle Name:LYNN
Last Name:PETRELLA
Suffix:
Gender:F
Credentials:CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 ELLISDALE RD
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08501-1508
Mailing Address - Country:US
Mailing Address - Phone:609-218-0892
Mailing Address - Fax:
Practice Address - Street 1:74 ELLISDALE RD
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08501-1508
Practice Address - Country:US
Practice Address - Phone:609-218-0892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-08
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA237865174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN