Pettrey, Johanna Christine

Pettrey, Johanna Christine is an individual health care provider with primary practice located at 1515 W Fir St , Portales NM 88130-5703. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as her primary health care specialty. Pettrey, Johanna Christine can be contacted via phone (575) 356-6695.

Contact Information

Primary practice address
1515 W Fir St Portales NM 88130-5703
Phone: (575) 356-6695
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X R47083 New Mexico
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 0001144582 Virginia
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X CNP01151 New Mexico

Profile Details

NPI number 1265413447
LBN Legal business name Pettrey, Johanna Christine
Credentials FNP-BC
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 7th, 2005
Last updated Apr 24th, 2024 - about 7 months ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1265413447 NPPES
New Mexico MEDICAID G7157

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