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General NPI Number Information
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NPI Number | 1184099988
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Entity Type | Individual
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Provider Name | MOLLY M. ETUE PA
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Gender | Female
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Dates
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Enumeration Date | 12/04/2015
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Last Update Date | 12/26/2024
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Provider Practice Location Address
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Address Line | 1990 HOSPITAL DR STE 110
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City | SEDRO WOOLLEY
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State | WA
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Zip | 98284-9315
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Country | US
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Telephone | 360-856-8830
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Fax | 360-714-2520
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Provider Business Mailing Address
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Address Line | 11109 PARKVIEW PLAZA DR # 117
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City | FORT WAYNE
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State | IN
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Zip | 46845-1701
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Country | US
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Telephone |
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5136
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA61638047
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 10002892A
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License Number State | IN
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