Individual
TINESHA SHANTA PETTIWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
205 E MEDICAL CENTER BLVD # 100, WEBSTER, TX 77598-4376
(346) 800-6001
Mailing address
12700 STAFFORD RD APT 1321, STAFFORD, TX 77477-3576
(205) 401-7386
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
1129705
TX
363LF0000X
Family Nurse Practitioner
1129705
TX
363LG0600X
Gerontology Nurse Practitioner
Primary
1129705
TX
Other
Enumeration date
07/25/2023
Last updated
10/16/2023
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