Mary Petruzzi, APRN
Individual provider Active NPI Family Nurse Practitioner · Minnetonka, MN
NPI 1922048073 · NPPES record last updated Mar 3, 2021
Key facts
- NPI
- 1922048073
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- RN2269965 (MA)
- Practice address
- 9900 Bren Rd E
Minnetonka, MN 55343-9664 - Phone
- (203) 605-0804
- NPI assigned
- Jun 7, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 002938 | CT | MD | Professional Counselor |
| RN2269965 | MA | MD | Family Nurse Practitioner |
| F333230-1 | NY | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Advanced Care Associates, LLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | F333230-1 | NY | |
| Family Nurse Practitioner | 363LF0000X | 002938 | CT | |
| Family Nurse Practitioner | 363LF0000X | RN2269965 | MA | Yes |
Addresses
Primary practice location
9900 Bren Rd E
Minnetonka, MN 55343-9664
Mailing address
126 Sherman Hill Rd Apt C10
Woodbury, CT 06798-3641
Phone (203) 605-0804
Other providers in Minnetonka, MN
- Debra J Peterson
- Gretchen Elsa Peterson
- Kathleen Marie Frischmann Peterson
- Sieglinde Iris Peterson
- Melissa Ann Petoletti
- Laura Marie Pett
- John Adam Petty
- Jennifer Petzoldt
- Crystal A Pfisterer
- Laura Jean Philbrook
All providers in Minnetonka, MN · Family Nurse Practitioner in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 3, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.