Provider Demographics
NPI:1881238442
Name:ETIENNE, JOELLE
Entity type:Individual
Prefix:
First Name:JOELLE
Middle Name:
Last Name:ETIENNE
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 1:941 MCLEAN AVE APT 212
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10704-4107
Mailing Address - Country:US
Mailing Address - Phone:347-248-2775
Mailing Address - Fax:
Practice Address - Street 1:941 MCLEAN AVE APT 212
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10704-4107
Practice Address - Country:US
Practice Address - Phone:347-248-2775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-06
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program