Provider Demographics
NPI:1326062845
Name:PETTRY, NANETTE BURFIELD (CRNP)
Entity Type:Individual
Prefix:
First Name:NANETTE
Middle Name:BURFIELD
Last Name:PETTRY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 BROOKWOOD BLVD
Mailing Address - Street 2:SUITE 401
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-6862
Mailing Address - Country:US
Mailing Address - Phone:205-870-0256
Mailing Address - Fax:205-870-7107
Practice Address - Street 1:125 W HAGUE RD
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-5814
Practice Address - Country:US
Practice Address - Phone:915-532-1620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-056480363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51530417OtherBLUE CROSS
AL051530417Medicare ID - Type Unspecified
S71716Medicare UPIN