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1962120667
DAVONTE PETTIS
PORTLAND, OR
NPI
1962120667
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
3747P1801X Technician, Personal Care Attendant
Enumeration Date
2022-08-18
Last Update Date
2022-08-18
Business Address
DAVONTE PETTIS
5725 NE PRESCOTT ST
PORTLAND, OR 97218-2275
Phone number: 503-402-8101
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Mailing Address
DAVONTE PETTIS
PO BOX 8459
PORTLAND, OR 97207-8459
Phone number:
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