Individual
ELIZABETH M PETTIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6868 S ASH ST, OAK CREEK, WI 53154-1604
(414) 254-9434
(414) 215-7227
Mailing address
6868 S ASH ST, OAK CREEK, WI 53154-1604
(414) 254-9434
(414) 215-7227
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100067661
—
WI
Enumeration date
02/05/2020
Last updated
02/05/2020
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