Provider Demographics
NPI:1518029941
Name:POPE, ETHAN J (APRN)
Entity Type:Individual
Prefix:
First Name:ETHAN
Middle Name:J
Last Name:POPE
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 WEST ST STE E
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002-2967
Mailing Address - Country:US
Mailing Address - Phone:413-461-0315
Mailing Address - Fax:413-439-2989
Practice Address - Street 1:441 WEST ST STE E
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-2967
Practice Address - Country:US
Practice Address - Phone:413-461-0315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN256469364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health