Individual
STEVEN ETIENNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDMT
Contact information
Practice address
3278 MITCHELL BLVD, MOODY AFB, GA 31699-1500
(229) 257-4466
Mailing address
3278 MITCHELL BLVD, MOODY AFB, GA 31699-1500
(229) 257-4466
Taxonomy
Speciality
Code
Description
License number
State
146M00000X
Intermediate Emergency Medical Technician
Primary
E3054072
GA
163WM0705X
Medical-Surgical Registered Nurse
RN225389
GA
Other
Enumeration date
04/24/2013
Last updated
04/24/2013
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