Provider Demographics
NPI:1780429522
Name:PETTIES, ERICA
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:PETTIES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4108 DARTMOOR CT
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-7743
Mailing Address - Country:US
Mailing Address - Phone:571-201-7903
Mailing Address - Fax:
Practice Address - Street 1:211 COASTAL AVE
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-6861
Practice Address - Country:US
Practice Address - Phone:571-201-7903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-25
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy