Provider Demographics
NPI:1366197402
Name:PETRIELLA, REBEKAH PAIGE (FNP)
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:PAIGE
Last Name:PETRIELLA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 26TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-7611
Mailing Address - Country:US
Mailing Address - Phone:828-962-8481
Mailing Address - Fax:
Practice Address - Street 1:6047 TYVOLA GLEN CIR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217-6431
Practice Address - Country:US
Practice Address - Phone:443-383-9300
Practice Address - Fax:855-866-8710
Is Sole Proprietor?:No
Enumeration Date:2022-02-17
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1151725363L00000X
SCAPN.28370363L00000X
NC5015845363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNNK757AOtherMEDICARE
NCQ00382662OtherRAILROAD MEDICARE
NC1366197402Medicaid