Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 0102201977 | VA |
NPI | 1043353774 |
---|---|
Provider Name | Dr. Adrienne Dawn Pettebone |
First Address | Portsmouth, VA 23708-2197 |
Second Address | Portsmouth, VA 23708-2197 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2007 |
Last Update Date | 23/11/2015 |