Basic Information
| Provider Information | |||||||||
| NPI: | 1689322398 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PETIT | ||||||||
| FirstName: | ROBERT | ||||||||
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| Credential: | RN ARNP STUDENT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 31224 121ST LN SE | ||||||||
| Address2: | |||||||||
| City: | AUBURN | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980920902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2534867599 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9330 59TH AVE SW | ||||||||
| Address2: | |||||||||
| City: | LAKEWOOD | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984992858 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2535817020 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/11/2022 | ||||||||
| LastUpdateDate: | 05/05/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WE0003X | RN60659272 | WA | Y | Nursing Service Providers | Registered Nurse | Emergency |
No ID Information.