MS. JENNIFER RUTH PETTIBONE RN NPI 1003004474

NPI Information

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
Phone: (707) 784-2154
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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 Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	163WP0808X	Registered Nurse	Psychiatric/Mental Health	464317	CALIFORNIA	Yes

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: 11/14/2023

NPI Synchronization or Removal

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