Provider Demographics
NPI:1811271851
Name:PETROSYAN, IRINA IGOREVNA
Entity type:Individual
Prefix:
First Name:IRINA
Middle Name:IGOREVNA
Last Name:PETROSYAN
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 1:1695 TREETOP DR
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16509-6941
Mailing Address - Country:US
Mailing Address - Phone:814-882-5411
Mailing Address - Fax:
Practice Address - Street 1:1695 TREETOP DR
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16509-6941
Practice Address - Country:US
Practice Address - Phone:814-882-5411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN287001164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse