Wanda Pettye

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

043071327 Issued in IL

Practice address

3618 Western Ave
Park Forest, IL 60466-2126

Phone

(708) 228-0999

NPI assigned

Aug 3, 2010

Last updated

Aug 3, 2010By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1280793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1280793600000",
    "number": "1780998674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3618 WESTERN AVE",
            "city": "PARK FOREST",
            "state": "IL",
            "postal_code": "604662126",
            "telephone_number": "708-228-0999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3618 WESTERN AVE",
            "city": "PARK FOREST",
            "state": "IL",
            "postal_code": "604662126",
            "telephone_number": "708-228-0999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTYE",
        "first_name": "WANDA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-08-03",
        "last_updated": "2010-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "IL",
            "license": "043071327",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Park Forest - Chicago Heights School District 163
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• Ramin Ghazizadeh LLC (Park Forest Podiatry)

• Licensed Practical Nurse in Park Forest, IL
• Providers in Park Forest, IL by specialty
• Licensed Practical Nurse in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2010; 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.