Provider Demographics
NPI:1366280851
Name:PETRUCCIANI, ALEXA
Entity type:Individual
Prefix:
First Name:ALEXA
Middle Name:
Last Name:PETRUCCIANI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6336 AVALON LANE EAST DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-5080
Mailing Address - Country:US
Mailing Address - Phone:317-690-0271
Mailing Address - Fax:
Practice Address - Street 1:6336 AVALON LANE EAST DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-5080
Practice Address - Country:US
Practice Address - Phone:317-690-0271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-18
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program