Individual
MANOUCHKA L ETIENNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1600 ELLIS ST, BRUNSWICK, GA 31520-6737
(912) 289-2006
Mailing address
6548 CONSTANCE ST, LAKE WORTH, FL 33467-7660
(561) 307-7859
(561) 307-7859
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
13129
GA
Other
Enumeration date
06/09/2025
Last updated
06/09/2025
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