Provider Demographics
NPI:1639292311
Name:PETTIBON, NANCY JOYCE (CRNFA)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:JOYCE
Last Name:PETTIBON
Suffix:
Gender:F
Credentials:CRNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9040 E BEAR CREEK DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85749-9642
Mailing Address - Country:US
Mailing Address - Phone:253-720-3117
Mailing Address - Fax:520-545-7250
Practice Address - Street 1:1200 N EL DORADO PL
Practice Address - Street 2:BLD E SUITE 520
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-4637
Practice Address - Country:US
Practice Address - Phone:520-209-2500
Practice Address - Fax:520-545-7250
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN180728163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
1639292311OtherNPI