Provider Demographics
NPI:1790873792
Name:ETRE, MOULINE (MD)
Entity Type:Individual
Prefix:DR
First Name:MOULINE
Middle Name:
Last Name:ETRE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 SOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-1628
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:235 CANTRELL
Practice Address - Street 2:JMU HEALTH CENTER MSC 7901
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22807
Practice Address - Country:US
Practice Address - Phone:540-568-6178
Practice Address - Fax:540-568-6176
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101047946207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAE74066Medicare UPIN