Healthcare Provider Details

I. General information

NPI: 1013427822
Provider Name (Legal Business Name): FATIMAH RASUL-PETTIGREW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2017
Last Update Date: 10/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 BEAR CORBITT RD
BEAR DE
19701-1323
US

IV. Provider business mailing address

23 ORMONDE CIR
SMYRNA DE
19977-4024
US

V. Phone/Fax

Practice location:
  • Phone: 267-258-7419
  • Fax:
Mailing address:
  • Phone: 267-258-7419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: