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NPI Code Detail

MEDICARE: MS. DANETTE PETTIGREW R.N.

MEDICARE: MS. DANETTE PETTIGREW R.N.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse361165OH

General Provider Information

NPI Number : 1013273879
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. DANETTE PETTIGREW R.N.
Provider Business Mailing Address
First Line : 1086 HILLSTONE RD
Second Line :
City : CLEVELAND HEIGHTS
State : OH
Zip : 44121-2472
Country : US
Telephone Number : 216-513-8068
Fax Number :
Provider Business Practice Location Address
First Line : 400 E STATE ST STE D
Second Line :
City : ATHENS
State : OH
Zip : 45701-1870
Country : US
Telephone Number : 740-249-4514
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/05/2012
Last Update Date : 10/22/2024

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