Provider Demographics
NPI:1770346504
Name:PETTIT, JADE ALYXANDRA (RN)
Entity type:Individual
Prefix:MRS
First Name:JADE
Middle Name:ALYXANDRA
Last Name:PETTIT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:55930 BLUE EAGLE RD
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97707-2369
Mailing Address - Country:US
Mailing Address - Phone:541-640-2518
Mailing Address - Fax:541-550-2919
Practice Address - Street 1:55930 BLUE EAGLE RD
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97707-2369
Practice Address - Country:US
Practice Address - Phone:541-640-2518
Practice Address - Fax:541-550-2919
Is Sole Proprietor?:No
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201141655RN163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health