Provider Demographics
NPI:1043467434
Name:PETIT, MARY KINT (NP)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:KINT
Last Name:PETIT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:LOUISE
Other - Last Name:KINT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:950 VICTORS WAY
Mailing Address - Street 2:STE. 100
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108
Mailing Address - Country:US
Mailing Address - Phone:734-926-4800
Mailing Address - Fax:734-973-0595
Practice Address - Street 1:3100 PROFESSIONAL DRIVE
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104
Practice Address - Country:US
Practice Address - Phone:734-926-4800
Practice Address - Fax:734-973-0595
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-27
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704224847363LW0102X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology