Individual
KIMYATA LATRICE PETTAWAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2005 ASHLAND AVE, TOLEDO, OH 43620-1703
(419) 841-7701
Mailing address
2005 ASHLAND AVE, TOLEDO, OH 43620-1703
(419) 255-9585
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN.446147
OH
163WC1500X
Community Health Registered Nurse
RN.446147
OH
Other
Enumeration date
01/29/2018
Last updated
05/02/2023
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