Individual
MRS. AMY DIETZEN PETTICREW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
6324 FAIRVIEW RD, SUITE 201, CHARLOTTE, NC 28210-3271
(704) 384-0588
Mailing address
PO BOX 60447, SUITE 200, CHARLOTTE, NC 28260-0447
(704) 384-0588
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-05569
NC
Other
Enumeration date
02/16/2015
Last updated
04/26/2023
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