Individual provider · Type 1 NPI

Nicole Theodora Pettway, LPN

Licensed Practical Nurse · Detroit, MI

NPI number 1891091773 Active

Practice location

20201 Asbury Park St
Detroit, MI 48235

Call (313) 826-4449 Map

Mailing address

20201 Asbury Park
Detroit, MI 48235-2102

Specialties and licenses

Taxonomy	Code	License
Licensed Practical Nurse Primary	164W00000X	4703101683 (MI)

Licensed Practical Nurse: An individual with post-high school vocational training and practical experience in the provision of nursing care at a level less than that required for certification as a Registered Nurse. Requirements for education, experience, licensure, and job responsibilities vary among the states.

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About NPI 1891091773

Nicole Theodora Pettway, LPN's National Provider Identifier is 1891091773, issued on Feb 10, 2011. The primary taxonomy on file is Licensed Practical Nurse (164W00000X), and the practice location is in Detroit, MI. The record was last updated on Feb 10, 2011.