Basic Information
| Provider Information | |||||||||
| NPI: | 1366197402 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PETRIELLA | ||||||||
| FirstName: | REBEKAH | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1718 8TH STREET DR NE APT 203 | ||||||||
| Address2: | |||||||||
| City: | HICKORY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286012479 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8289628481 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1224 COMMERCE ST SW STE A | ||||||||
| Address2: | |||||||||
| City: | CONOVER | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286138245 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282610467 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/17/2022 | ||||||||
| LastUpdateDate: | 07/13/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | MOON-YR3E0 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.