Individual
CHRISTOPHER ETIENNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4825 92ND ST, ELMHURST, NY 11373-4052
(929) 240-8996
Mailing address
4825 92ND ST, ELMHURST, NY 11373-4052
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
335732
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
335732
—
NY
Enumeration date
06/25/2021
Last updated
06/25/2021
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