Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 176B00000X | Midwife | 10077R | NM |
Y | 176B00000X | Midwife | 99062 | TX |
NPI | 1144572264 |
---|---|
Provider Name | A'maya Ettien |
First Address | El Paso, TX 79932-2028 |
Second Address | El Paso, TX 79932-2028 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2012 |
Last Update Date | 12/10/2012 |