Colleen Flora Petullo, NP-C
Nurse Practitioner, Family in Prescott Valley, AZ. Individual provider (NPI-1).
NPI number1790333003
StatusActive
Last updated in NPPESDec 9, 2020
Details
- NPI
- 1790333003
- Entity type
- Individual (NPI-1)
- Name
- Colleen Flora Petullo
- Credential
- NP-C
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Aug 29, 2019
- Certification date
- Dec 9, 2020
- Last updated
- Dec 9, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LF0000X | Nurse Practitioner, Family | RNP227728 | AZ | Yes |
| 363LF0000X | Nurse Practitioner, Family | 59225 | NM |
Practice location
9695 N. Fiorella St.Prescott Valley, AZ 86315
Phone 702-460-9009
Mailing address
9695 N. Fiorella St.Prescott Valley, AZ 86315
Phone 928-312-2030
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