Provider Demographics
NPI:1265911895
Name:PETTITT, JULIANE (LVN)
Entity type:Individual
Prefix:
First Name:JULIANE
Middle Name:
Last Name:PETTITT
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 1:445 CAMBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:TX
Mailing Address - Zip Code:76179-1276
Mailing Address - Country:US
Mailing Address - Phone:254-485-5376
Mailing Address - Fax:
Practice Address - Street 1:1255 W 15TH ST STE 600
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-4211
Practice Address - Country:US
Practice Address - Phone:866-889-3500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX219769164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse