Individual
MICHAEL GLENN PETTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN, ACNS-BC, CCNS
Contact information
Practice address
500 HARVARD ST SE, MINNEAPOLIS, MN 55455-0363
(612) 273-5607
(612) 273-9966
Mailing address
7615 XERXES AVE S, RICHFIELD, MN 55423-3546
(612) 273-5607
(612) 273-9966
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
095570
MN
364SA2200X
Adult Health Clinical Nurse Specialist
Primary
71
MN
364SC0200X
Critical Care Medicine Clinical Nurse Specialist
71
MN
Other
Enumeration date
04/20/2020
Last updated
04/20/2020
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