Provider Demographics
NPI:1700656113
Name:PETRELLA, ASHLEY ROSE
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:ROSE
Last Name:PETRELLA
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 1:49402 MONTE RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48047-4858
Mailing Address - Country:US
Mailing Address - Phone:586-630-9600
Mailing Address - Fax:
Practice Address - Street 1:41800 HAYES RD
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-1876
Practice Address - Country:US
Practice Address - Phone:586-203-2170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program