Michael Glenn Petty, RN, ACNS-BC, CCNS

Primary specialty

Adult Health Clinical Nurse SpecialistTaxonomy code 364SA2200X

License

71 Issued in MN

Practice address

500 Harvard St SE
Minneapolis, MN 55455-0363

Phone

(612) 273-5607

Fax

(612) 273-9966

NPI assigned

Apr 20, 2020

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1587340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1587340800000",
    "number": "1255951216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7615 XERXES AVE S",
            "city": "RICHFIELD",
            "state": "MN",
            "postal_code": "554233546",
            "telephone_number": "612-273-5607",
            "fax_number": "612-273-9966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 HARVARD ST SE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554550363",
            "telephone_number": "612-273-5607",
            "fax_number": "612-273-9966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTY",
        "first_name": "MICHAEL",
        "middle_name": "GLENN",
        "credential": "RN, ACNS-BC, CCNS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-04-20",
        "last_updated": "2020-04-20",
        "certification_date": "2020-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WC0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Critical Care Medicine",
            "state": "MN",
            "license": "095570",
            "primary": false
        },
        {
            "code": "364SC0200X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Critical Care Medicine",
            "state": "MN",
            "license": "71",
            "primary": false
        },
        {
            "code": "364SA2200X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Adult Health",
            "state": "MN",
            "license": "71",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Svetlana Petrovich, LICSW
• Anna Petryk, MD
• Lance E Petschl, LADC
• Kelly S Petska, PH.D.
• Linda Pettersen, LP, PHD
• Robert A Petzel, MD
• Sue V Petzel, PHD
• Roxanne Stacey Peyton, MSW
• Kelly E Pezzella, NP
• Elizabeth Pfaff

• Adult Health Clinical Nurse Specialist in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Adult Health Clinical Nurse Specialist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.