Provider Demographics
NPI:1356430029
Name:PETRO-KREAHLING, DEBORAH LEE (CLINICAL NURSE SPEC)
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:LEE
Last Name:PETRO-KREAHLING
Suffix:
Gender:F
Credentials:CLINICAL NURSE SPEC
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:LEE
Other - Last Name:PETRO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:301 STEEPLE CHASE DRIVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678
Mailing Address - Country:US
Mailing Address - Phone:410-535-4854
Mailing Address - Fax:410-535-6272
Practice Address - Street 1:301 STEEPLE CHASE DRIVE
Practice Address - Street 2:SUITE 104
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678
Practice Address - Country:US
Practice Address - Phone:410-535-4854
Practice Address - Fax:410-535-6272
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR112052101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OTH000Medicare UPIN