Individual
IRINA SERGEEVNA PETTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
2000 TAMARACK RD, NEWARK, OH 43055
(220) 564-4650
(220) 564-4238
Mailing address
2000 TAMARACK RD, NEWARK, OH 43055
(220) 564-4650
(220) 564-4238
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
003613
OH
Other
Enumeration date
11/17/2012
Last updated
04/02/2021
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