Provider Demographics
NPI:1942967633
Name:PETTY, MONICA (HHA)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:PETTY
Suffix:
Gender:F
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1218 NOTTINGHAM LN
Mailing Address - Street 2:
Mailing Address - City:NEW CANEY
Mailing Address - State:TX
Mailing Address - Zip Code:77357-3313
Mailing Address - Country:US
Mailing Address - Phone:346-364-6457
Mailing Address - Fax:
Practice Address - Street 1:1218 NOTTINGHAM LN
Practice Address - Street 2:
Practice Address - City:NEW CANEY
Practice Address - State:TX
Practice Address - Zip Code:77357-3313
Practice Address - Country:US
Practice Address - Phone:346-364-6457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-17
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide