Individual
MATTHEW D. PETTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
628 MADISON ST, PORT TOWNSEND, WA 98368-4414
(402) 990-0733
Mailing address
628 MADISON ST, PORT TOWNSEND, WA 98368-4414
(402) 990-0733
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
60552041
WA
367500000X
Certified Registered Nurse Anesthetist
AP60548506
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1376569954
NPI
WA
05
—
2046617
—
WA
Enumeration date
07/15/2006
Last updated
10/22/2025
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