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MS. JENNIFER RUTH PETTIBONE RN NPI 1003004474


NPI Profile

NPI: 1003004474
Provider Name: MS. JENNIFER RUTH PETTIBONE, RN
Classification:Registered Nurse - 163WP0808X
Entity Type: Individual

Specialization: Psychiatric/Mental Health

Address:
2101 COURAGE DR
MS-10-200
FAIRFIELD, CA
ZIP 94533
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Phone: (707) 784-2154

MS. Jennifer Ruth Pettibone, RN is a psychiatric/mental health registered nurse in Fairfield, CA. MS. Jennifer Ruth Pettibone, RN NPI is 1003004474. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

2101 COURAGE DR
MS-10-200
FAIRFIELD, CA
ZIP 94533-717
Phone: (707) 784-2154

The enumeration date for this NPI number is 10/10/2007 and was last updated on 10/10/2007.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1163WP0808XRegistered NursePsychiatric/Mental Health464317CALIFORNIAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 6/14/2021

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.