Provider Demographics
NPI:1003199662
Name:PETTIFORD, BETTY J (CNA)
Entity type:Individual
Prefix:
First Name:BETTY
Middle Name:J
Last Name:PETTIFORD
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 PYRUS CT
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-4073
Mailing Address - Country:US
Mailing Address - Phone:336-314-3359
Mailing Address - Fax:
Practice Address - Street 1:8 PYRUS CT
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-4073
Practice Address - Country:US
Practice Address - Phone:336-314-3559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide