IndividualActive
Jennifer Pettibone, RN
NPI 1003004474 · Psychiatric/Mental Health Registered Nurse · Fairfield, CA
Provider details
- NPI number
- 1003004474
- Entity type
- Individual
- Primary specialty
- Psychiatric/Mental Health Registered NurseNursing Service Providers
- Credential
- RN
- Sex
- Female
- Sole proprietor
- No
- License
- 464317 (CA)
Specialties & taxonomies
Nursing Service Providers
Practice location
2101 Courage Dr
Ms-10-200
Fairfield, CA 94533-6717
Phone: (707) 784-2154
Approximate (ZIP-level) locationGet directions
Mailing address
1048 2nd St Apt 6
Novato, CA 94945-2439
Registry dates
- Enumerated
- 2007-10-10
- Last updated
- 2007-10-10
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.