Individual
KAILEE DAWN PETRO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
720 ESKENAZI AVE, INDIANAPOLIS, IN 46202-5187
(317) 274-0275
(317) 274-0256
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
28202456A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001551098
ANTHEM PTAN
IN
05
—
300051716
—
IN
Enumeration date
06/04/2021
Last updated
12/03/2024
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