Individual
KIMBERLY DAWN PETTINELLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
3605 MAYFAIR AVE, HIBBING, MN 55746-2935
(218) 262-3441
(218) 362-6908
Mailing address
3605 MAYFAIR AVE, HIBBING, MN 55746-2935
(218) 262-3441
(218) 362-6908
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
129504-7
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1659664852
—
MN
01
—
500006831
MN MEDICARE NUMBER PTAN
MN
Enumeration date
05/20/2011
Last updated
05/06/2014
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