Provider Demographics
NPI:1760489033
Name:HOWANSKY, PETRUSIA ANN (DPM)
Entity Type:Individual
Prefix:DR
First Name:PETRUSIA
Middle Name:ANN
Last Name:HOWANSKY
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 E BETHANY HOME RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-1207
Mailing Address - Country:US
Mailing Address - Phone:602-264-9121
Mailing Address - Fax:602-264-9122
Practice Address - Street 1:520 E BETHANY HOME RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-1207
Practice Address - Country:US
Practice Address - Phone:602-264-9121
Practice Address - Fax:602-264-9122
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0535213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0194260OtherBLUE CROSS BLUE SHIELD AZ
AZ575483Medicaid
AZ480032678OtherPALMETTO
AZ5662648OtherAETNA
AZ126004OtherHEALTH NET
AZ861027930OtherOTHER COMMERCIAL INSURANC
AZU64518Medicare UPIN
AZ575483Medicaid