Provider Demographics
NPI:1902230592
Name:PETTIGREW, MICHELE BRITTANY (LPN)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:BRITTANY
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:PO BOX 584
Mailing Address - Street 2:53 WEST ING STREET
Mailing Address - City:KINGSTON
Mailing Address - State:OH
Mailing Address - Zip Code:45644-0584
Mailing Address - Country:US
Mailing Address - Phone:740-466-7116
Mailing Address - Fax:
Practice Address - Street 1:53 W. ING STREET
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:OH
Practice Address - Zip Code:45644-0584
Practice Address - Country:US
Practice Address - Phone:740-466-7116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-30
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH140107164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse