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Individual

MITTIE R PETTAWAY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
3014 LOGAN ST, FORESTVILLE, MD 20747-2727
(301) 789-4064
Mailing address
3014 LOGAN ST, FORESTVILLE, MD 20747-2727
(301) 789-4064

Taxonomy

Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary

Other

Enumeration date
09/11/2017
Last updated
07/21/2022
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