Provider Demographics
NPI:1699191551
Name:PETRUCELLI, ELIZABETH (CCCE)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:PETRUCELLI
Suffix:
Gender:F
Credentials:CCCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6532 TRAPPERS TRAIL AVE
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-2760
Mailing Address - Country:US
Mailing Address - Phone:303-478-3736
Mailing Address - Fax:
Practice Address - Street 1:6532 TRAPPERS TRAIL AVE
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-2760
Practice Address - Country:US
Practice Address - Phone:303-478-3736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-14
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No174H00000XOther Service ProvidersHealth Educator