Individual
KAITLIN ETZCORN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
5050 N CLINTON ST, FORT WAYNE, IN 46825-5886
(260) 484-8551
Mailing address
10227 GREENMOOR DR, NEW HAVEN, IN 46774-2287
(260) 602-7795
Taxonomy
Speciality
Code
Description
License number
State
163WX0800X
Orthopedic Registered Nurse
28197283A
IN
363LF0000X
Family Nurse Practitioner
Primary
71011071A
IN
Other
Enumeration date
11/20/2020
Last updated
08/13/2021
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