Provider Demographics
NPI:1962071720
Name:PETREY, ANNA MICHELLE
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:MICHELLE
Last Name:PETREY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 SE 136TH AVE UNIT 118
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-6954
Mailing Address - Country:US
Mailing Address - Phone:806-676-3303
Mailing Address - Fax:
Practice Address - Street 1:9317 NE HIGHWAY 99 STE M
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665-8900
Practice Address - Country:US
Practice Address - Phone:360-787-9315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-24
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator