Provider Demographics
NPI:1568906444
Name:PETTIGREW, TERESA A (LPN)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:A
Last Name:PETTIGREW
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 NEW PROSPECT CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29625-5044
Mailing Address - Country:US
Mailing Address - Phone:864-260-5195
Mailing Address - Fax:
Practice Address - Street 1:126 NEW PROSPECT CHURCH RD
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29625-5044
Practice Address - Country:US
Practice Address - Phone:864-260-5195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-12
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23625164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse