MS. JENNIFER RUTH PETTIBONE RN NPI 1003004474

Registered Nurse (Psych/Mental Health) in Fairfield, CA

About JENNIFER PETTIBONE

Jennifer Pettibone is a provider in Fairfield, CA. The NPI number assigned to this provider is 1003004474. The practitioner's primary taxonomy code is Registered Nurse (163WP0808X). The provider is registered as an individual and their NPI record was last updated 10 years ago.

NPI1003004474 Additional informationCallout TooltipNational Provider Indentifier (NPI)
The 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.
Provider NameMS. JENNIFER RUTH PETTIBONE RN
Provider Location Address2101 COURAGE DR MS-10-200 FAIRFIELD, CA 94533 Additional informationCallout TooltipProvider location address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Mailing Address1048 2ND ST APT 6 NOVATO, CA 94945 Additional informationCallout TooltipProvider mailing address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.
GenderFemale
NPI Entity TypeIndividual Additional informationCallout TooltipEntity type code
The code describing the type of health care provider that is being assigned an NPI.
Codes are:
1 = (Person): individual human being who furnishes health care;
2 = (Non-person): entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO).
Is Sole Proprietor?No
Is Organization Subpart?N/A Additional informationCallout TooltipWhat is a subpart?
Subparts are the components and separate physical locations of organization health care providers. Examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.
Enumeration Date10-10-2007 Additional informationCallout TooltipProvider enumeration date
The date the provider was assigned a unique identifier (assigned an NPI)
Last Update Date10-10-2007 Additional informationCallout TooltipLast update date
The date that a record was last updated or changed.

Business Address

MS. JENNIFER RUTH PETTIBONE RN
2101 COURAGE DR
MS-10-200
FAIRFIELD, CA
ZIP 94533
Phone: (707) 784-2154
Get Directions

Mailing Address

MS. JENNIFER RUTH PETTIBONE RN
1048 2ND ST APT 6
NOVATO, CA
ZIP 94945
Phone: (415) 897-1899

Primary Taxonomy

Taxonomy Code163WP0808X Additional informationCallout TooltipPrimary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
ClassificationRegistered Nurse
TypeNursing Service Providers
SpecializationPsych/Mental Health
License No.464317
License StateCA

Map Location


MS. JENNIFER RUTH PETTIBONE RN address is 2101 COURAGE DR MS-10-200 FAIRFIELD, CA 94533

Other Providers at the same location


The following 20 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1023178308MS. CYNTHIA LYNN BOTT LCSW
Individual
Social Worker (Clinical)2101 COURAGE DR
FAIRFIELD, CA 94533
(707) 784-2140
1023182979DR. ROBERT PETER DICKEY MD
Individual
Pediatrics2101 COURAGE DR
FAIRFIELD, CA 94533
(707) 784-8662
1083774814MS. MICHELLE GERSON MFT
Individual
Marriage & Family Therapist2101 COURAGE DR
FAIRFIELD, CA 94533
(707) 784-2070
1235244294 HOMAYOUN FAGHIHI-SHIRAZI M.D.
Individual
Psychiatry & Neurology (Psychiatry)2101 COURAGE DR
FAIRFIELD, CA 94533
(707) 435-2077
1306906474 LEO HELMUTH SADDAM RN
Individual
2101 COURAGE DR
FAIRFIELD, CA 94533
(707) 784-2101
1316025216 XING-XING LUO MD
Individual
Psychiatry & Neurology (Psychiatry)2101 COURAGE DR
FAIRFIELD, CA 94533
(707) 784-2080
1336208784 KELLIE MARIE KEKKI LCSW
Individual
Social Worker (Clinical)2101 COURAGE DR MS 10-100
FAIRFIELD, CA 94533
(707) 784-2010
1346300480 PRISCILLA MARIA DE LEON
Individual
Counselor (Mental Health)2101 COURAGE DR
FAIRFIELD, CA 94533
(707) 784-2140
1396736732MS. SARAH JANE BOLGER RNP
Individual
Nurse Practitioner (Family)2101 COURAGE DR
FAIRFIELD, CA 94533
(707) 784-2048
1417017732 ANNE EN-LIN LEE RD
Individual
Dietitian, Registered2101 COURAGE DR MS 10-100
FAIRFIELD, CA 94533
(707) 435-2213
1427139864DR. LAURIE MATIASEVICH DDS
Individual
Dentist (Dental Public Health)2101 COURAGE DR
FAIRFIELD, CA 94533
(707) 784-2120
1447336508TELECARE CORPORATION
Organization
Psychiatric Hospital2101 COURAGE DR
FAIRFIELD, CA 94533
(707) 784-2130
1487715710 JULIE L. COOPER R.N.
Individual
Registered Nurse (Psych/Mental Health)2101 COURAGE DR
FAIRFIELD, CA 94533
(707) 784-2140
1518027309 KATHY DEMAGGIO RD
Individual
Dietitian, Registered2101 COURAGE DR NUTRITION, MS 10-100
FAIRFIELD, CA 94533
(707) 784-2216
1700946035 NICOLE LUCCHESI
Individual
Marriage & Family Therapist2101 COURAGE DR
FAIRFIELD, CA 94533
(707) 784-2140
1770643074MR. ALFREDO ENRIQUE GOMEZ PSYCHOTHERAPIST
Individual
Marriage & Family Therapist2101 COURAGE DR 10-100
FAIRFIELD, CA 94533
(707) 784-2285
1811087232MISS ANNA MARIE ANTONIO FNP
Individual
Nurse Practitioner (Family)2101 COURAGE DR
FAIRFIELD, CA 94533
(707) 784-2010
1821103730DR. RAYMOND M. REYES M.D.
Individual
Psychiatry & Neurology (Psychiatry)2101 COURAGE DR BOX 4090, MAIL STATION 10-300
FAIRFIELD, CA 94533
(707) 435-2080
1851327316MRS. SARAH KATHERINE LAYE M.S., R.D.
Individual
Dietitian, Registered2101 COURAGE DR MS 10-100, SCH AND SS
FAIRFIELD, CA 94533
(707) 435-2213
1992865224 CARRIE BERNICE BLOOM
Individual
Counselor (Mental Health)2101 COURAGE DR
FAIRFIELD, CA 94533
(707) 784-2140