Provider Demographics
NPI:1457131146
Name:PETRONICK, BRATINA KIMBERLY
Entity Type:Individual
Prefix:
First Name:BRATINA
Middle Name:KIMBERLY
Last Name:PETRONICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9545 BOUNDARY LN
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44130-5208
Mailing Address - Country:US
Mailing Address - Phone:440-241-3525
Mailing Address - Fax:
Practice Address - Street 1:7997 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44103-4226
Practice Address - Country:US
Practice Address - Phone:216-851-1880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH104038033363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health