Provider Demographics
NPI:1912009606
Name:PETTIET, DONNA (LVN)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:PETTIET
Suffix:
Gender:F
Credentials:LVN
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 3067
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77305
Mailing Address - Country:US
Mailing Address - Phone:936-756-8331
Mailing Address - Fax:936-760-2898
Practice Address - Street 1:1020 RIVERWOOD COURT
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304
Practice Address - Country:US
Practice Address - Phone:936-756-8331
Practice Address - Fax:936-760-2898
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115975164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse