Individual
CAROL ANNE PETTIBONE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1840 GRAY LYNN DR, WALLA WALLA, WA 99362-9247
(509) 529-3447
Mailing address
1840 GRAY LYNN DR, WALLA WALLA, WA 99362-9247
(509) 529-3447
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
310601
WA
Other
Enumeration date
09/11/2023
Last updated
09/11/2023
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