| Doctor Name: | MS. JENNIFER RUTH PETTIBONE |
| NPI Number: | 1003004474 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN |
| License Number: | 464317 |
| Business Practice Address: | 2101 Courage Dr Ms-10-200 Fairfield, CA - 945336717 |
| Business Phone Number: | 7077842154 |
| Business Fax Number: | |
| Mailing Address: | 1048 2nd St Apt 6, NOVATO |
| State: | CA |
| Postal Code: | 949452439 |
| Phone Number: | 4158971899 |
| Fax Number: | |
| NPI Enumeration Date: | 10/10/2007 |
| NPI Last Update Date: | 10/10/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WP0808X |
| License Number: | 464317 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Psych/Mental Health |
| Taxonomy Definition: | |