Individual
DR. LAQUETTA NICOL PETTWAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD.19390
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
051119644
BCBS
AL
01
—
1376588095
TRICARE SOUTH
AL
Enumeration date
06/17/2006
Last updated
12/01/2025
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