Individual
MRS. COLLEN IRENE PETRIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
114 2ND AVE, 1ST HOUSE ON RIGHT, CAROGA LAKE, NY 12032
(518) 630-7191
Mailing address
P.O. BOX 599, 114 SECOND AVE, CAROGA LAKE, NY 12032
(518) 630-7191
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
150371-1
NY
Other
Enumeration date
12/08/2008
Last updated
06/03/2013
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