Healthcare Provider Details

I. General information

NPI: 1134330319
Provider Name (Legal Business Name): CATHLEEN PETITJEAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70B MIDDLE ST
SOUTH DARTMOUTH MA
02748-3100
US

IV. Provider business mailing address

70B MIDDLE ST
SOUTH DARTMOUTH MA
02748-3100
US

V. Phone/Fax

Practice location:
  • Phone: 508-992-5961
  • Fax:
Mailing address:
  • Phone: 508-992-5961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number167519
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: