Most Relevant Information
Provider Data
| NPI Number: | 1003004474 |
| Provider Name: | JENNIFER RUTH PETTIBONE RN |
| Entity Type: | Individual |
| Taxonomy Code: | 163WP0808X |
| Specialty: | Registered Nurse |
| License Number: | 464317 |
Most Important Dates
| Enumeration Date: | 10/10/2007 |
| Last Updated: | 10/10/2007 |
Provider Practice Location
2101 COURAGE DR
MS-10-200
FAIRFIELD
CA
945336717
Practice Location Phone/Fax
| Phone: | 7077842154 |
| Fax: |
Provider Mailing Location
1048 2ND ST APT 6
NOVATO
CA
949452439
Provider Mailing Phone/Fax
| Phone: | 4158971899 |
| Fax: |