Individual
MRS. GENA MARIE ETTINGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
505 S NOLEN DR STE B, SOUTHLAKE, TX 76092-9167
(817) 410-7777
(817) 410-9906
Mailing address
PO BOX 35629, DALLAS, TX 75235-0629
(214) 424-2213
(214) 231-2159
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA08076
TX
Other
Enumeration date
10/03/2012
Last updated
07/09/2021
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