Provider Demographics
NPI:1689671505
Name:PETROS, HELEN (NP, PA-C)
Entity Type:Individual
Prefix:
First Name:HELEN
Middle Name:
Last Name:PETROS
Suffix:
Gender:F
Credentials:NP, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4366 KUKUI GROVE ST
Mailing Address - Street 2:STE 201
Mailing Address - City:LIHUE
Mailing Address - State:HI
Mailing Address - Zip Code:96766-2006
Mailing Address - Country:US
Mailing Address - Phone:808-263-3233
Mailing Address - Fax:808-263-3220
Practice Address - Street 1:3455 MAIN ST STE 5
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1147
Practice Address - Country:US
Practice Address - Phone:413-733-9600
Practice Address - Fax:413-732-6534
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN146587363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
970026776OtherRAILROAD MEDICARE
146587OtherCONNECTICARE
970026776OtherRAILROAD MEDICARE
146587OtherCONNECTICARE