Provider Demographics
NPI:1235176215
Name:ETHERTON, ELIZABETH M (CNP)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:M
Last Name:ETHERTON
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
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Mailing Address - Street 1:5400 GIBSON BLVD SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-4729
Mailing Address - Country:US
Mailing Address - Phone:505-262-7960
Mailing Address - Fax:505-232-1368
Practice Address - Street 1:5400 GIBSON BLVD SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-4729
Practice Address - Country:US
Practice Address - Phone:505-262-7248
Practice Address - Fax:505-262-3190
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2015-06-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NMCNP04157363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q45332Medicare UPIN