Provider Demographics
NPI:1679144794
Name:ETTER, EMILY JIANMING
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:JIANMING
Last Name:ETTER
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 1:28 CRESCENT ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-3650
Mailing Address - Country:US
Mailing Address - Phone:860-358-4805
Mailing Address - Fax:860-358-6094
Practice Address - Street 1:28 CRESCENT ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-3650
Practice Address - Country:US
Practice Address - Phone:860-358-5322
Practice Address - Fax:860-358-6298
Is Sole Proprietor?:No
Enumeration Date:2021-07-09
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical