Individual provider Active NPI

Debra W. Petro, APRN

  • Child & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist
  • Dover, DE
National Provider Identifier
1265582670
Registry record updated Apr 2, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Child & Adolescent Psychiatric/Mental Health Clinical Nurse SpecialistTaxonomy code 364SP0807X
License
LE-0000183 Issued in DE
Practice address
121 W Loockerman St
Dover, DE 19904-7325
Phone
(302) 674-1397
NPI assigned
Jan 11, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 2, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Child & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist 364SP0807X LE-0000183 DE Primary

Addresses

Primary practice location

121 W Loockerman St
Dover, DE 19904-7325

Mailing address

117 Dungarvan Drive
Middletown, DE 19709
Phone (302) 690-2872

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
LE-0000183DEMDChild & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1333324800000",
    "number": "1265582670",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "117 DUNGARVAN DRIVE",
            "city": "MIDDLETOWN",
            "state": "DE",
            "postal_code": "19709",
            "telephone_number": "302-690-2872"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 W LOOCKERMAN ST",
            "city": "DOVER",
            "state": "DE",
            "postal_code": "199047325",
            "telephone_number": "302-674-1397"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRO",
        "first_name": "DEBRA",
        "middle_name": "W.",
        "name_prefix": "Mrs.",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-11",
        "last_updated": "2012-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "364SP0807X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Psychiatric/Mental Health, Child & Adolescent",
            "state": "DE",
            "license": "LE-0000183",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dover, DE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.