Provider Demographics
NPI:1750172839
Name:PETRUCCI, LOUISE FRASER (RN)
Entity type:Individual
Prefix:
First Name:LOUISE
Middle Name:FRASER
Last Name:PETRUCCI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 MARSEILLES ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48224-1479
Mailing Address - Country:US
Mailing Address - Phone:313-290-2250
Mailing Address - Fax:
Practice Address - Street 1:4300 MARSEILLES ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48224-1479
Practice Address - Country:US
Practice Address - Phone:313-290-2250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-16
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704181297163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty