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General NPI Number Information
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NPI Number | 1497039432
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Entity Type | Individual
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Provider Name | NELSON J PETTEY
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Gender | Male
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Dates
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Enumeration Date | 10/10/2011
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Last Update Date | 10/10/2011
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Provider Practice Location Address
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Address Line | 1423 CHAPEL ST
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City | NEW HAVEN
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State | CT
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Zip | 06511-4411
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Country | US
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Telephone | 203-865-3852
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Fax |
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Provider Business Mailing Address
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Address Line | 193 THOMPSON ST UNIT A
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City | EAST HAVEN
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State | CT
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Zip | 06513-1912
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Country | US
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Telephone |
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 090629
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License Number State | CT
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