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Individual

TINA MARIE PETTWAY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LPN

Contact information

Practice address
4040 MEMORIAL PKWY SW, HUNTSVILLE, AL 35802-4364
(256) 533-1970
(256) 705-6477
Mailing address
237 AMBER LN, HARVEST, AL 35749-9339
(256) 337-7747

Taxonomy

Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
2-065334
AL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
330000014
AL
Enumeration date
02/19/2018
Last updated
02/19/2018
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