Provider Demographics
NPI:1093861205
Name:ETCHINGHAM, NANCY SUE (ISC)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:SUE
Last Name:ETCHINGHAM
Suffix:
Gender:F
Credentials:ISC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1327 DANA AVE
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-2403
Mailing Address - Country:US
Mailing Address - Phone:307-672-5011
Mailing Address - Fax:307-674-7529
Practice Address - Street 1:1327 DANA AVE
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-2403
Practice Address - Country:US
Practice Address - Phone:307-672-5011
Practice Address - Fax:307-674-7529
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator