Healthcare Provider Details

I. General information

NPI: 1699568212
Provider Name (Legal Business Name): CRISTINA MIHAELA PETTY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CRISTINA MIHAELA DRAGAN

II. Dates (important events)

Enumeration Date: 05/27/2025
Last Update Date: 04/18/2026
Certification Date: 04/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1208 E CROSS ST
CENTERVILLE IA
52544-3501
US

IV. Provider business mailing address

2416 LOCUST ST
WEST DES MOINES IA
50265-4123
US

V. Phone/Fax

Practice location:
  • Phone: 515-212-3997
  • Fax: 515-513-1744
Mailing address:
  • Phone: 702-339-2167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF03250482
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: