Individual
SHERYL J ETNIER-COLON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
11050 PARKVIEW CIRCLE DR, FORT WAYNE, IN 46845
(833) 724-8326
(260) 425-6845
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
4704298582
MI
363L00000X
Nurse Practitioner
Primary
71000289A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000727554
ANTHEM
IN
01
—
000000729198
ANTHEM
IN
05
—
200880090
—
IN
01
—
351955872084
TRICARE
IN
01
—
9203774
AETNA
IN
01
—
P01157111
RR MEDICARE
IN
Enumeration date
06/09/2006
Last updated
01/05/2023
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