Provider Demographics
NPI:1023386893
Name:ETTENGER, JANET (CD)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:ETTENGER
Suffix:
Gender:F
Credentials:CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30717 EL PEQUENO DR
Mailing Address - Street 2:
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265-3101
Mailing Address - Country:US
Mailing Address - Phone:310-435-6543
Mailing Address - Fax:310-457-5585
Practice Address - Street 1:30717 EL PEQUENO DR
Practice Address - Street 2:
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265-3101
Practice Address - Country:US
Practice Address - Phone:310-435-6543
Practice Address - Fax:310-457-5585
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula