Active NPI
Maureen Pettis
- Home Health Registered Nurse
- Churchville, NY
National Provider Identifier
1861965733
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Health Registered Nurse
- License
- 425455-1
- Practice address
- 46 Rochelle Dr
Churchville, NY 14428-9765 - Phone
- (585) 329-5855
- NPI assigned
- Jan 3, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Registered Nurse | 163WH0200X | 425455-1 | NY | Primary |
Addresses
Primary practice location
46 Rochelle Dr
Churchville, NY 14428-9765
Mailing address
46 Rochelle Dr
Churchville, NY 14428-9765
Phone (585) 329-5855
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 425455-1 | NY | MD | Home Health Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1546473600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1546473600000",
"number": "1861965733",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "46 ROCHELLE DR",
"city": "CHURCHVILLE",
"state": "NY",
"postal_code": "144289765",
"telephone_number": "585-329-5855"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "46 ROCHELLE DR",
"city": "CHURCHVILLE",
"state": "NY",
"postal_code": "144289765",
"telephone_number": "585-329-5855"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETTIS",
"first_name": "MAUREEN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-01-03",
"last_updated": "2019-01-03",
"status": "A"
},
"taxonomies": [
{
"code": "163WH0200X",
"taxonomy_group": "",
"desc": "Registered Nurse, Home Health",
"state": "NY",
"license": "425455-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Churchville, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.