Provider Demographics
NPI:1952016586
Name:PETRUCCELLI, VICTORIA (FNP)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:PETRUCCELLI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 N MADISON ST
Mailing Address - Street 2:
Mailing Address - City:MINNEOTA
Mailing Address - State:MN
Mailing Address - Zip Code:56264-9215
Mailing Address - Country:US
Mailing Address - Phone:240-281-8362
Mailing Address - Fax:
Practice Address - Street 1:308 N MADISON ST
Practice Address - Street 2:
Practice Address - City:MINNEOTA
Practice Address - State:MN
Practice Address - Zip Code:56264-9215
Practice Address - Country:US
Practice Address - Phone:240-281-8362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8070363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily