Most Relevant Information
Provider Data
| NPI Number: | 1386647337 |
| Provider Name: | EDWARD K PETRUSCH CRNA |
| Entity Type: | Individual |
| Taxonomy Code: | 367500000X |
| Specialty: | Nurse Anesthetist, Certified Registered |
| License Number: | 820A |
Most Important Dates
| Enumeration Date: | 05/23/2005 |
| Last Updated: | 04/11/2013 |
Provider Practice Location
444 COLLETT BRIDGE RD
ALVATON
KY
421229675
Practice Location Phone/Fax
| Phone: | 2708420433 |
| Fax: |
Provider Mailing Location
444 COLLETT BRIDGE RD
ALVATON
KY
421229675
Provider Mailing Phone/Fax
| Phone: | 2708420433 |
| Fax: |