Individual
FAITH ELIZABETH ETHERINGTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
7601 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4133
(260) 436-8686
(260) 436-8585
Mailing address
PO BOX 2526, FORT WAYNE, IN 46801-2526
(866) 413-9534
(260) 407-4428
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10002881A
IN
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300033208
—
IN
Enumeration date
11/06/2019
Last updated
05/18/2022
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