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Individual

JENNIFER L ETLING

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
6 JUNGERMANN CIRCLE, STE 205, ST PETERS, MO 63376
(636) 441-2122
(636) 441-5290
Mailing address
6 JUNGERMANN CIRCLE, STE 205, ST PETERS, MO 63376
(636) 441-2122
(636) 441-5290

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
2005000203
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
017283
EXCLUSIVE CHOICE
01
12593
ESSENCE
01
165817
BLUE SHIELD
01
1700267
UNITED HEALTHCARE
05
209370105
MO
01
231210
GHP
01
4309109800
PRODENTIAL
01
487573
HEALTHLINK
01
7986366
AETNA
01
H74520
MERCY
01
M6725
MEDICARE ARKANSAS
01
P00195292
RAILROAD MEDICARE
Enumeration date
04/05/2006
Last updated
01/06/2022
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