Individual
JENNIFER INGLE PETTIGREW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
151 N SUNRISE AVE, STE. 611, ROSEVILLE, CA 95661-2924
(916) 789-1505
(916) 789-1513
Mailing address
151 N SUNRISE AVE, STE. 611, ROSEVILLE, CA 95661-2924
(916) 789-1505
(916) 789-1513
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
M1784
TX
207RN0300X
Nephrology Physician
Primary
A107629
CA
207RN0300X
Nephrology Physician
M1784
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
176965505
—
TX
01
—
8AC882
BCBS
TX
Enumeration date
08/24/2006
Last updated
08/12/2009
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