Individual
LAVERN WATSON PETTAWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
1515 OLD BAINBRIDGE RD, TALLAHASSEE, FL 32303-5340
(850) 606-8010
(850) 487-7954
Mailing address
1515 OLD BAINBRIDGE RD, TALLAHASSEE, FL 32303-5340
(850) 606-8010
(850) 487-7954
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
ARNP 2226142
FL
Other
Enumeration date
05/02/2013
Last updated
05/02/2013
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