Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 358684 | CA |
NPI | 1003091620 |
---|---|
Provider Name | Renee Etienne |
First Address | Grass Valley, CA 95945-9514 |
Second Address | Grass Valley, CA 95945-9514 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2008 |
Last Update Date | 02/01/2008 |