| NPI | 1023455425 |
|---|---|
| Former Name | COLLEEN MEGAN PETTREY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 2018-02540) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2018-02540) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: GA 87092) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101264545) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WV 28183) | |
| Enumeration Date | 2013-05-28 |
| Last Update Date | 2025-03-16 |