Provider Demographics
NPI:1356629802
Name:PETITTE, TRISHA MARY (NP)
Entity Type:Individual
Prefix:
First Name:TRISHA
Middle Name:MARY
Last Name:PETITTE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9190
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26506-9190
Mailing Address - Country:US
Mailing Address - Phone:304-293-1084
Mailing Address - Fax:
Practice Address - Street 1:104 FRONT STREET
Practice Address - Street 2:
Practice Address - City:MOUNT MORRIS
Practice Address - State:PA
Practice Address - Zip Code:15349
Practice Address - Country:US
Practice Address - Phone:724-324-9001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-02
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP011429363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health