Provider Demographics
NPI:1922431501
Name:PETROCELLI, LYNN N (CRNP)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:N
Last Name:PETROCELLI
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:N
Other - Last Name:PFEUFFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:170 JAMISON LN STE C
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-2327
Mailing Address - Country:US
Mailing Address - Phone:412-646-1339
Mailing Address - Fax:412-646-1072
Practice Address - Street 1:4373 OLD WILLIAM PENN HWY STE 204
Practice Address - Street 2:
Practice Address - City:MURRYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15668-1926
Practice Address - Country:US
Practice Address - Phone:412-646-1339
Practice Address - Fax:412-646-1087
Is Sole Proprietor?:No
Enumeration Date:2013-08-19
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP013089363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA309588SDBMedicare PIN