Individual
MR. DENIS ETTA AWU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
133 PARK STREET, MALONE, NY 12953
(678) 665-1056
Mailing address
133 PARK STREET, MALONE, NY 12953
(678) 665-1056
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
110076
GA
Other
Enumeration date
02/12/2016
Last updated
02/12/2016
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