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NPI Code Detail

MEDICARE: PRECIOUS A PETTAWAY

MEDICARE: PRECIOUS A PETTAWAY
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
1225400000XRehabilitation Practitioner

General Provider Information

NPI Number : 1992053037
Entity Type Code : Individual
Provider Name (Legal Business Name) : PRECIOUS A PETTAWAY
Provider Business Mailing Address
First Line : 3624 RUSSIAN OLIVE ST
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89032-7643
Country : US
Telephone Number : 702-353-1079
Fax Number :
Provider Business Practice Location Address
First Line : 3624 RUSSIAN OLIVE ST
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89032-7643
Country : US
Telephone Number : 702-353-1079
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/21/2012
Last Update Date : 08/21/2012

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Directions to “ PRECIOUS A PETTAWAY ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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