Healthcare Provider Details

I. General information

NPI: 1922282391
Provider Name (Legal Business Name): KARIN A PETTIT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2007
Last Update Date: 12/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9330 BROADWAY
CROWN POINT IN
46307-8602
US

IV. Provider business mailing address

9330 BROADWAY
CROWN POINT IN
46307-8602
US

V. Phone/Fax

Practice location:
  • Phone: 219-662-0001
  • Fax:
Mailing address:
  • Phone: 219-662-0001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number28135742A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: