Provider Demographics
NPI:1396733580
Name:PETREYE, SHIRLEY DOLS (ARNP)
Entity type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:DOLS
Last Name:PETREYE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 BOXWOOD LN
Mailing Address - Street 2:
Mailing Address - City:PEARISBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24134-1168
Mailing Address - Country:US
Mailing Address - Phone:540-921-6110
Mailing Address - Fax:540-921-3796
Practice Address - Street 1:430 BOXWOOD LN
Practice Address - Street 2:
Practice Address - City:PEARISBURG
Practice Address - State:VA
Practice Address - Zip Code:24134-1168
Practice Address - Country:US
Practice Address - Phone:540-921-6110
Practice Address - Fax:540-921-3796
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3187042363LF0000X
VA0024172441363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3187042OtherLICENSE