Individual
THERESA PETTAWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PCD,DONA
Contact information
Practice address
624 MASON AVE, DREXEL HILL, PA 19026-2430
(610) 553-5481
(610) 553-5482
Mailing address
624 MASON AVE, DREXEL HILL, PA 19026-2430
(610) 553-5481
(610) 553-5482
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
—
—
374J00000X
Doula
Primary
18087
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1043794560002
—
PA
05
—
233089455
—
PA
Enumeration date
04/18/2017
Last updated
07/10/2025
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