Provider Demographics
NPI:1881932077
Name:PETTY, KAREN SUE (STNA)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:SUE
Last Name:PETTY
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4750 OURAY CT
Mailing Address - Street 2:
Mailing Address - City:LIBERTY TWP
Mailing Address - State:OH
Mailing Address - Zip Code:45011-7403
Mailing Address - Country:US
Mailing Address - Phone:513-737-4357
Mailing Address - Fax:
Practice Address - Street 1:4750 OURAY CT
Practice Address - Street 2:
Practice Address - City:LIBERTY TWP
Practice Address - State:OH
Practice Address - Zip Code:45011-7403
Practice Address - Country:US
Practice Address - Phone:513-737-4357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-22
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide