Provider Demographics
NPI:1942280110
Name:PETRILLO, JEFFREY PATRICK (CRNA)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:PATRICK
Last Name:PETRILLO
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 FLINT DR
Mailing Address - Street 2:
Mailing Address - City:HARLEYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19438-1862
Mailing Address - Country:US
Mailing Address - Phone:215-513-9333
Mailing Address - Fax:215-513-0118
Practice Address - Street 1:1330 POWELL ST
Practice Address - Street 2:
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19401-3353
Practice Address - Country:US
Practice Address - Phone:610-270-2717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN317474L/52264367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered