Individual
ISHONDA SHANICE PETTAWAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
2005 ASHLAND AVE, TOLEDO, OH 43620-1703
(419) 841-7701
Mailing address
2005 ASHLAND AVE, TOLEDO, OH 43620-1703
(419) 841-7701
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
170748
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LPN-170748
LPN
OH
Enumeration date
05/22/2019
Last updated
04/10/2025
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