Individual
JENNIFER PETTIBONE GASTENVELD
Active
Individual
JENNIFER PETTIBONE GASTENVELD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
327169
OH
363L00000X
Nurse Practitioner
327169
OH
363LA2200X
Adult Health Nurse Practitioner
Primary
327169
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3050764
—
OH
05
—
7100116680
—
KY
Enumeration date
05/05/2010
Last updated
06/26/2015
Update your record
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