Annie Ruth Petteys, RN, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

576378 Issued in CA

Practice address

2801 Atlantic Ave
Long Beach, CA 90806-1701

Phone

(562) 933-8100

NPI assigned

Apr 21, 2015

Sex

Female

Sole proprietor

Yes

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

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Registered Nurse

State licenses

Interoperability endpoints

• Direct secure messaging: apetteysrn3039@direct.memorialcare.org

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

{
    "created_epoch": "1429574400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1429574400000",
    "number": "1720475361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2801 ATLANTIC AVE",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908061701",
            "telephone_number": "562-933-8100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2801 ATLANTIC AVE",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908061701",
            "telephone_number": "562-933-8100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTEYS",
        "first_name": "ANNIE",
        "middle_name": "RUTH",
        "credential": "RN, FNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-04-21",
        "last_updated": "2015-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "576378",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "576378",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristen Marie Petrillo, PT, DPT
• Nanelle Tesoro Petrocik, RN
• Joshua Petrone
• Albert A Petrossian, M.D.
• Larissa Mary Petrosspour, DDS
• Duane L. Pettit, O.D.
• Vanessa L Pezo, LCSW
• Jacey Pezoldt
• Kristin Marie Pfeifer
• Pham & Cao Dental Corp.

• Family Nurse Practitioner in Long Beach, CA
• Providers in Long Beach, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.