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General NPI Number Information
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NPI Number | 1528020328
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Entity Type | Individual
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Provider Name | JENNIFER L ETLING MD
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Gender | Female
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Dates
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Enumeration Date | 04/05/2006
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Last Update Date | 01/06/2022
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Provider Practice Location Address
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Address Line | 6 JUNGERMANN CIRCLE STE 205
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City | ST PETERS
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State | MO
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Zip | 63376
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Country | US
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Telephone | 636-441-2122
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Fax | 636-441-5290
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Provider Business Mailing Address
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Address Line | 6 JUNGERMANN CIRCLE STE 205
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City | ST PETERS
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State | MO
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Zip | 63376
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Country | US
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Telephone | 636-441-2122
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Fax | 636-441-5290
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 2005000203
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License Number State | MO
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