Provider Demographics
NPI:1376962555
Name:NORTON, ETTA
Entity Type:Individual
Prefix:
First Name:ETTA
Middle Name:
Last Name:NORTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13432 ELMWOOD DR
Mailing Address - Street 2:SUITE 5
Mailing Address - City:BAXTER
Mailing Address - State:MN
Mailing Address - Zip Code:56425-8538
Mailing Address - Country:US
Mailing Address - Phone:218-454-0995
Mailing Address - Fax:
Practice Address - Street 1:13432 ELMWOOD DR
Practice Address - Street 2:SUITE 5
Practice Address - City:BAXTER
Practice Address - State:MN
Practice Address - Zip Code:56425-8538
Practice Address - Country:US
Practice Address - Phone:218-454-0995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-15
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1674171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist