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General NPI Number Information
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NPI Number | 1164261426
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Entity Type | Individual
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Provider Name | VIRGINIA PETTWAY DNP, PNP-PC
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Gender | Female
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Dates
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Enumeration Date | 05/24/2024
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Last Update Date | 05/24/2024
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Provider Practice Location Address
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Address Line | 1995 SAINT MATTHEWS RD
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City | ORANGEBURG
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State | SC
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Zip | 29118-2405
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Country | US
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Telephone | 803-928-5525
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Fax |
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Provider Business Mailing Address
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Address Line | 11 YEADON AVE
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City | CHARLESTON
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State | SC
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Zip | 29407-7327
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Country | US
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Telephone | 423-802-7524
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 28786
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License Number State | SC
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