Provider Demographics
NPI:1902945389
Name:ETTENGER, JOYCE (CRNP)
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:
Last Name:ETTENGER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1706 BALTIMORE PIKE
Mailing Address - Street 2:
Mailing Address - City:GETTYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17325-7088
Mailing Address - Country:US
Mailing Address - Phone:717-845-9683
Mailing Address - Fax:717-843-2698
Practice Address - Street 1:728 S BEAVER ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-2209
Practice Address - Country:US
Practice Address - Phone:717-845-9683
Practice Address - Fax:717-843-2698
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP000136F363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50057484OtherCAPITAL BLUE CROSS
PAET746782OtherHIGHMARK BLUE SHIELD