Provider Demographics
NPI:1649085804
Name:PETTINGILL, CARSON WILLIAM
Entity type:Individual
Prefix:
First Name:CARSON
Middle Name:WILLIAM
Last Name:PETTINGILL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2630 E STRINGHAM AVE APT A309
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84109-4906
Mailing Address - Country:US
Mailing Address - Phone:435-319-9515
Mailing Address - Fax:
Practice Address - Street 1:1516 S 1100 E STE A
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84105-2577
Practice Address - Country:US
Practice Address - Phone:435-287-4197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-12
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program