Provider Demographics
NPI:1407482227
Name:PETTIGREW-FLETCHER, GLORIA
Entity Type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:
Last Name:PETTIGREW-FLETCHER
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 1:12432 A 36TH ST
Mailing Address - Street 2:C20
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68123
Mailing Address - Country:US
Mailing Address - Phone:402-598-8363
Mailing Address - Fax:888-743-1329
Practice Address - Street 1:12432 A 36TH ST
Practice Address - Street 2:C20
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68123
Practice Address - Country:US
Practice Address - Phone:402-598-8363
Practice Address - Fax:888-743-1329
Is Sole Proprietor?:No
Enumeration Date:2020-03-13
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEREGISTRY1037172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE043812531OtherIN HOME PERSONAL SERVICES, CMA