Provider Demographics
NPI:1538550876
Name:ETTLINGER, ROCHELLE BELL (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:ROCHELLE
Middle Name:BELL
Last Name:ETTLINGER
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 HIGHLAND AVENUE
Mailing Address - Street 2:WINCHESTER HOSPITAL-DEPARTMENT OF PSYCHIATRY
Mailing Address - City:WINCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01890-1496
Mailing Address - Country:US
Mailing Address - Phone:781-756-2734
Mailing Address - Fax:781-756-7283
Practice Address - Street 1:41 HIGHLAND AVENUE
Practice Address - Street 2:WINCHESTER HOSPITAL-DEPARTMENT OF PSYCHIATRY
Practice Address - City:WINCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01890-1496
Practice Address - Country:US
Practice Address - Phone:781-756-2734
Practice Address - Fax:781-756-7283
Is Sole Proprietor?:No
Enumeration Date:2015-02-09
Last Update Date:2017-05-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MARN2278013364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS400206481Medicare UPIN