Provider Demographics
NPI:1255767695
Name:PETRIN, ROBERTA ANN (LICENSED NURES ASSIS)
Entity type:Individual
Prefix:MS
First Name:ROBERTA
Middle Name:ANN
Last Name:PETRIN
Suffix:
Gender:F
Credentials:LICENSED NURES ASSIS
Other - Prefix:MRS
Other - First Name:ROBERTA
Other - Middle Name:ANN
Other - Last Name:HODGDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1039 ISLINGTON STREET
Mailing Address - Street 2:SUITE 16
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801
Mailing Address - Country:US
Mailing Address - Phone:603-431-0505
Mailing Address - Fax:603-431-2228
Practice Address - Street 1:1039 ISLINGTON STREET
Practice Address - Street 2:SUITE 16
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801
Practice Address - Country:US
Practice Address - Phone:603-431-0505
Practice Address - Fax:603-431-2228
Is Sole Proprietor?:No
Enumeration Date:2013-09-17
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH035334-25376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide