Mary Therese Petrella, ND MS RN FNP BC

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

Practice address

2970 Chartres
Hygienic Institute Community Health Clinic
La Salle, IL 61301

Phone

(815) 223-0196

Fax

(815) 223-0358

NPI assigned

Aug 4, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Mary Therese Lauric Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science, Registered Nurse

State licenses

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

{
    "created_epoch": "1154649600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1922016849",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24007 MAJESTIC DRIVE",
            "city": "MINOOKA",
            "state": "IL",
            "postal_code": "60447",
            "telephone_number": "815-467-2871"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2970 CHARTRES",
            "address_2": "HYGIENIC INSTITUTE COMMUNITY HEALTH CLINIC",
            "city": "LA SALLE",
            "state": "IL",
            "postal_code": "61301",
            "telephone_number": "815-223-0196",
            "fax_number": "815-223-0358"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRELLA",
        "first_name": "MARY",
        "middle_name": "THERESE",
        "name_prefix": "Mrs.",
        "credential": "ND MS RN FNP BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-04",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "LAURIC",
            "middle_name": "THERESE",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Jeanna Richelle Olivero
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• Scott Payne
• James Richard Pelton, DO
• Glen R Peterson, D.C.
• Pharmblue Illinois LLC
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• Shelly D Punke, LCPC
• Restorative Home Health Care, LLC
• John A Sawicki, LMT

• All providers in La Salle, IL
• Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.