Individual
JESSICA ETTEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
30 BEE ST, CHARLESTON, SC 29425-3068
(843) 876-8216
Mailing address
PO BOX 751461, CHARLOTTE, NC 28275-1461
(843) 792-6200
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
2322258
MA
363L00000X
Nurse Practitioner
Primary
2322258
MA
363L00000X
Nurse Practitioner
28528
SC
Other
Enumeration date
05/27/2018
Last updated
04/03/2024
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