Individual
MS. ANNE MARIE PETTIBONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
975 SERENO DR, VALLEJO, CA 94589-2441
(707) 651-4742
Mailing address
975 SERENO DR, VALLEJO, CA 94589-2441
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
3322
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RN4506780
MEDI-CAL RENDERING NUMBER
CA
Enumeration date
12/21/2006
Last updated
01/03/2022
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