| NPI | 1174679518 |
|---|---|
| Former Name | THERESA MARIE PETTY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 117563) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MO 117563) |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2019-05-15 |