Individual
CARRIE A ETTENBERGER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
20 PAGE DR, PINEHURST, NC 28374-8847
(910) 621-2937
Mailing address
20 PAGE DR, PINEHURST, NC 28374-8847
(607) 368-0075
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
91029
NC
Other
Enumeration date
11/02/2021
Last updated
11/02/2021
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