Provider Demographics
NPI:1346439841
Name:PETTY, ELIZABETH CODY (RNC)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:CODY
Last Name:PETTY
Suffix:
Gender:F
Credentials:RNC
Other - Prefix:MRS
Other - First Name:ELIZABETH
Other - Middle Name:CODY
Other - Last Name:FRANTZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RNC
Mailing Address - Street 1:901 GOODYEAR AVE
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35903-1106
Mailing Address - Country:US
Mailing Address - Phone:256-492-7800
Mailing Address - Fax:256-494-5536
Practice Address - Street 1:901 GOODYEAR AVE
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35903-1106
Practice Address - Country:US
Practice Address - Phone:256-492-7800
Practice Address - Fax:256-494-5536
Is Sole Proprietor?:No
Enumeration Date:2007-10-20
Last Update Date:2007-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-044133163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse