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NPI Code Detail

MEDICARE: DR. SHANNON MARIE ETTER M.D.

MEDICARE: DR. SHANNON MARIE ETTER M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207V00000XObstetrics & Gynecology Physician0101244203VA
2207V00000XObstetrics & Gynecology PhysicianC181763CA

General Provider Information

NPI Number : 1184829921
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SHANNON MARIE ETTER M.D.
Provider Business Mailing Address
First Line : 1 BOONE RD
Second Line : NAVAL HOSPITAL BREMERTON
City : BREMERTON
State : WA
Zip : 98312-1894
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 9455 CLAIREMONT MESA BLVD
Second Line :
City : SAN DIEGO
State : CA
Zip : 92123-1297
Country : US
Telephone Number : 858-266-5000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/20/2007
Last Update Date : 06/28/2023

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