Individual
ETHAN CONALL COLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
USS FRANK CABLE, UNIT 100105, AGUANA, GU 96567
(717) 601-4053
Mailing address
USS FRANK CABLE, UNIT 100105 BOX 216 FPO, AE 96567-0502, AGUANA, GU 96567
(717) 601-4053
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
CA
Other
Enumeration date
08/17/2022
Last updated
01/05/2023
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