Individual
BREONA PETTEWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
206 ERIE ST, SYRACUSE, NY 13204-1608
(631) 636-1772
Mailing address
108 W ELLIS ST, EAST SYRACUSE, NY 13057-2527
(631) 636-1772
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
331074-01
NY
Other
Enumeration date
07/26/2021
Last updated
08/10/2021
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