Provider Demographics
NPI:1922871227
Name:PETRILLO STRAUB, KRISTI (NP)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:
Last Name:PETRILLO STRAUB
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KRISTI
Other - Middle Name:
Other - Last Name:PETRILLO STRAUB
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AGNP-C
Mailing Address - Street 1:2913 KENSINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19134-3016
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2913 KENSINGTON AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-3016
Practice Address - Country:US
Practice Address - Phone:215-634-5272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-30
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN621580163WA0400X
PASP029090363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)