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NPI Code Detail

MEDICARE: SUSAN K ETHUN NP

MEDICARE: SUSAN K ETHUN NP
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
1363L00000XNurse Practitioner2407-033WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1821099813
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN K ETHUN NP
Provider Business Mailing Address
First Line : 2000 N DEWEY AVE
Second Line :
City : REEDSBURG
State : WI
Zip : 53959-1049
Country : US
Telephone Number : 608-768-6255
Fax Number : 608-524-0842
Provider Business Practice Location Address
First Line : 2000 N DEWEY AVE
Second Line :
City : REEDSBURG
State : WI
Zip : 53959-1049
Country : US
Telephone Number : 608-768-6255
Fax Number : 608-524-0842
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/02/2005
Last Update Date : 03/31/2008

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