Individual
NICOLE PETTYJOHN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
501 SILVERSIDE RD STE 102, WILMINGTON, DE 19809-1376
(443) 383-9300
(855) 866-8710
Mailing address
909 RIDGEBROOK RD STE 300, SPARKS, MD 21152-9477
(443) 383-9300
(855) 866-8710
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
L1-0047114
DE
363LF0000X
Family Nurse Practitioner
Primary
LG-0011811
DE
Other
Enumeration date
08/27/2015
Last updated
03/17/2023
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