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General NPI Number Information
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NPI Number | 1447784236
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Entity Type | Individual
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Provider Name | THERESA PETTAWAY PCD,DONA
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Gender | Female
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Dates
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Enumeration Date | 04/18/2017
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Last Update Date | 07/10/2025
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Provider Practice Location Address
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Address Line | 624 MASON AVE
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City | DREXEL HILL
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State | PA
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Zip | 19026-2430
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Country | US
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Telephone | 610-553-5481
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Fax | 610-553-5482
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Provider Business Mailing Address
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Address Line | 624 MASON AVE
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City | DREXEL HILL
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State | PA
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Zip | 19026-2430
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Country | US
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Telephone | 610-553-5481
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Fax | 610-553-5482
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 374J00000X
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Taxonomy Name | Doula
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License Number | 18087
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License Number State | PA
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