Provider Demographics
NPI:1750046348
Name:PETRIE, DENNIS JAMES (RN)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:JAMES
Last Name:PETRIE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3718 HARPER HILL RD SE
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-8872
Mailing Address - Country:US
Mailing Address - Phone:503-999-6360
Mailing Address - Fax:
Practice Address - Street 1:3718 HARPER HILL RD SE
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-8872
Practice Address - Country:US
Practice Address - Phone:503-999-6360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-08
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00167029163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse