Individual
LYRA PETTICREW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.ED.
Contact information
Practice address
110 LYNCH ST., WRANGELL, AK 99929-1231
(907) 874-3375
(907) 874-3339
Mailing address
PO BOX 2127, WRANGELL, AK 99929-2127
(907) 874-3375
(907) 874-3339
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
CM 1085
—
AK
Enumeration date
05/22/2007
Last updated
07/08/2007
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