Stacey Ann Pettorini, BSN,RN

Primary specialty

Administrator Registered NurseTaxonomy code 163WA2000X

License

111512 Issued in IA

Practice address

3600 30TH St
Des Moines, IA 50310-5753

Phone

(515) 699-3190

Fax

(515) 699-5736

NPI assigned

Jan 27, 2023

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Bachelor on Science - Nursing, Registered Nurse

State licenses

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

{
    "created_epoch": "1674777600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674777600000",
    "number": "1558077057",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3600 30TH ST",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503105753",
            "telephone_number": "515-699-3190",
            "fax_number": "515-699-5736"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3600 30TH ST",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503105753",
            "telephone_number": "515-699-3190",
            "fax_number": "515-699-5736"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTORINI",
        "first_name": "STACEY",
        "middle_name": "ANN",
        "credential": "BSN,RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-01-27",
        "last_updated": "2023-01-27",
        "certification_date": "2023-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WC0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Critical Care Medicine",
            "state": "IA",
            "license": "111512",
            "primary": false
        },
        {
            "code": "163WA2000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Administrator",
            "state": "IA",
            "license": "111512",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shannon E Peterson
• Shelly Ranee Peterson, MA,NMT FELLOW,MT-BC
• Brandon Petree, DO
• Krista Renee Pettepier, RN
• Jeffrey Pettit
• Matthew Gary Petty, M.D.
• Amy Peyton, LMSW
• Hunter Pflughaupt, MD
• Ashley Pfrimmer
• Jenny K Phabmixay, PHARM. D.

• Administrator Registered Nurse in Des Moines, IA
• Providers in Des Moines, IA by specialty
• Administrator Registered Nurse in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2023; 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.