Individual
MRS. JOHANNA CHRISTINE PETTREY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
1515 W FIR ST, PORTALES, NM 88130-5703
(575) 356-6695
Mailing address
912 W 21ST ST, CLOVIS, NM 88101-4154
(575) 935-9000
(575) 935-1002
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
0001144582
VA
363LF0000X
Family Nurse Practitioner
Primary
CNP01151
NM
363LF0000X
Family Nurse Practitioner
R47083
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
G7157
—
NM
Enumeration date
11/07/2005
Last updated
04/24/2024
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