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General NPI Number Information
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NPI Number | 1043308398
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Entity Type | Individual
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Provider Name | LUANN ETCHER N.P.
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Gender | Female
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 10/27/2015
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Provider Practice Location Address
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Address Line | 6150 OAK TREE BLVD SUITE 200
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City | INDEPENDENCE
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State | OH
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Zip | 44131-6917
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Country | US
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Telephone | 800-897-9177
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Fax | 800-470-8713
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Provider Business Mailing Address
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Address Line | 6149 N WAYNE RD
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City | WESTLAND
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State | MI
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Zip | 48185-7128
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Country | US
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Telephone | 734-728-2130
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Fax | 734-728-2626
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 4704155261
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License Number State | MI
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