Individual
MRS. JOELYN M ETGEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
770 E DUPONT RD, FORT WAYNE, IN 46825-2056
(260) 451-8242
Mailing address
770 E DUPONT RD, FORT WAYNE, IN 46825-2056
(260) 451-8242
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71003840A
IN
363LF0000X
Family Nurse Practitioner
COA 13375-NP
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0076586
—
OH
01
—
12330800
CAQH
—
05
—
201047530
—
IN
01
—
H149901
PTAN
OH
01
—
M40062495
PTAN
IN
Enumeration date
01/10/2012
Last updated
02/06/2023
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