Provider Demographics
NPI:1083296743
Name:PETTY, CORINGIA
Entity Type:Individual
Prefix:
First Name:CORINGIA
Middle Name:
Last Name:PETTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3255 23RD ST SE APT 13
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-2040
Mailing Address - Country:US
Mailing Address - Phone:202-422-8463
Mailing Address - Fax:
Practice Address - Street 1:3500 14TH ST NW APT 229
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-1334
Practice Address - Country:US
Practice Address - Phone:202-591-8623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-22
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant