Basic Information
| Provider Information | |||||||||
| NPI: | 1407976434 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PETTEI | ||||||||
| FirstName: | LINDA | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | C/O NORTHEAST MEDICAL GROUP, INC. | ||||||||
| Address2: | 226 MILL HILL AVE., 3RD FLOOR | ||||||||
| City: | BRIDGEPORT | ||||||||
| State: | CT | ||||||||
| PostalCode: | 066102826 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2033843199 | ||||||||
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| Practice Location | |||||||||
| Address1: | ONE HOSPITAL PLAZA | ||||||||
| Address2: | |||||||||
| City: | STAMFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032767111 | ||||||||
| FaxNumber: | 2032767081 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2007 | ||||||||
| LastUpdateDate: | 03/31/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | 6450 | CT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.