Provider Demographics
NPI:1770230708
Name:PETTOLINA, DANIELLE (CRNP)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:PETTOLINA
Suffix:
Gender:F
Credentials:CRNP
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3400 CIVIC CENTER BLVD
Mailing Address - Street 2:WEST PAVILION 1ST FL
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4306
Mailing Address - Country:US
Mailing Address - Phone:215-615-5864
Mailing Address - Fax:215-349-8432
Practice Address - Street 1:3400 CIVIC CENTER BLVD
Practice Address - Street 2:WEST PAVILION 1ST FL
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4306
Practice Address - Country:US
Practice Address - Phone:215-615-5864
Practice Address - Fax:215-349-8432
Is Sole Proprietor?:No
Enumeration Date:2022-03-09
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PASP025402363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily