Provider Demographics
NPI:1760171664
Name:PETTRY, HOPE MARIE
Entity Type:Individual
Prefix:
First Name:HOPE
Middle Name:MARIE
Last Name:PETTRY
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:PO BOX 26
Mailing Address - Street 2:
Mailing Address - City:LYNCO
Mailing Address - State:WV
Mailing Address - Zip Code:24857-0026
Mailing Address - Country:US
Mailing Address - Phone:304-923-9481
Mailing Address - Fax:
Practice Address - Street 1:223 CHARITY LN
Practice Address - Street 2:
Practice Address - City:CLEAR FORK
Practice Address - State:WV
Practice Address - Zip Code:24822-9720
Practice Address - Country:US
Practice Address - Phone:304-923-9481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-05
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant