Provider Demographics
NPI:1245310572
Name:PETTIT, KAREN SUE (CRNFA)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:SUE
Last Name:PETTIT
Suffix:
Gender:F
Credentials:CRNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16611 S 40TH ST
Mailing Address - Street 2:SUITE 180
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-0562
Mailing Address - Country:US
Mailing Address - Phone:480-785-2100
Mailing Address - Fax:480-290-7980
Practice Address - Street 1:16611 S 40TH ST
Practice Address - Street 2:SUITE 180
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-0562
Practice Address - Country:US
Practice Address - Phone:480-785-2100
Practice Address - Fax:480-290-7980
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN035022163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant