Individual provider · Type 1 NPI
Tinesha Shanta Pettiway
Gerontology Nurse Practitioner · Webster, TX
NPI number
1881375780
Active
Practice location
205 E Medical Center Blvd # 100
Webster, TX 77598-4376
Mailing address
12700 Stafford Rd Apt 1321
Stafford, TX 77477-3576
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Gerontology Nurse Practitioner Primary | 363LG0600X | 1129705 (TX) |
| Adult Health Nurse Practitioner | 363LA2200X | 1129705 (TX) |
| Family Nurse Practitioner | 363LF0000X | 1129705 (TX) |
Gerontology Nurse Practitioner: Definition to come...
Another provider at this address
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About NPI 1881375780
Tinesha Shanta Pettiway's National Provider Identifier is 1881375780, issued on Jul 25, 2023. The primary taxonomy on file is Gerontology Nurse Practitioner (363LG0600X), and the practice location is in Webster, TX. The record was last updated on Oct 16, 2023.