Individual
CANIVORY PETTIWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
855 CENTRAL AVE, ALBANY, NY 12206-1513
(518) 434-5678
Mailing address
114 UNIVERSITY AVE, ROCHESTER, NY 14605-2929
(585) 371-8373
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
349914
NY
Other
Enumeration date
08/02/2022
Last updated
08/02/2022
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