Individual
NICHOLAS J. PETELIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2301 HOLMES ST, KANSAS CITY, MO 64108-2640
(816) 404-1127
(816) 404-1103
Mailing address
2301 HOLMES ST, KANSAS CITY, MO 64108-2640
(816) 404-1127
(816) 404-1103
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
155240
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
919435404
—
MO
Enumeration date
10/18/2005
Last updated
12/01/2020
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