Individual
MS. CAROL PETRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
9 N CRANE AVE, SPENCER, IN 47460-1507
(812) 829-2237
(812) 829-6342
Mailing address
PO BOX 1329, BLOOMINGTON, IN 47402-1329
(812) 353-5855
(812) 353-5867
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71000346
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200202930A
—
IN
Enumeration date
05/12/2006
Last updated
07/28/2011
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