Individual
MARY ELIZABETH HERNANDEZ PETRULO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2107 CEDAR GROVE TRL APT 114, EAGAN, MN 55122-1612
(952) 210-6330
Mailing address
2107 CEDAR GROVE TRL APT 114, EAGAN, MN 55122-1612
(952) 210-6330
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
00883
MN
Other
Enumeration date
04/14/2021
Last updated
04/14/2021
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