Provider Demographics
NPI:1336729508
Name:ETZEL, BRITTNEY (NBC-HWC)
Entity Type:Individual
Prefix:
First Name:BRITTNEY
Middle Name:
Last Name:ETZEL
Suffix:
Gender:F
Credentials:NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15000 SW FARMINGTON RD APT 43
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007-2767
Mailing Address - Country:US
Mailing Address - Phone:503-804-2607
Mailing Address - Fax:
Practice Address - Street 1:15000 SW FARMINGTON RD APT 43
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97007-2767
Practice Address - Country:US
Practice Address - Phone:503-804-2607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORA-3271991