Healthcare Provider Details

I. General information

NPI: 1730041039
Provider Name (Legal Business Name): CAITLIN MARIE ETZLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2025
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

826 W KING ST
OWOSSO MI
48867-2120
US

IV. Provider business mailing address

5363 CHIN MAYA DR
SWARTZ CREEK MI
48473-8611
US

V. Phone/Fax

Practice location:
  • Phone: 989-720-2273
  • Fax:
Mailing address:
  • Phone: 810-280-5612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704341403
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: