Individual
LANCE MICHAEL PETTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
701 EDGEWATER DR STE 300, WAKEFIELD, MA 01880-6242
(781) 486-4116
Mailing address
18158 WOODSDALE CT, PORTER, TX 77365-3651
(281) 601-5565
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
345381
TX
Other
Enumeration date
10/29/2018
Last updated
10/29/2018
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