Provider Demographics
NPI:1649362898
Name:ETIENNE, MARIE ANGE (RD,LD)
Entity type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:ANGE
Last Name:ETIENNE
Suffix:
Gender:F
Credentials:RD,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5412 EASTBAY DR
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-5960
Mailing Address - Country:US
Mailing Address - Phone:561-963-8746
Mailing Address - Fax:561-963-8746
Practice Address - Street 1:7305 N MILITARY TRL
Practice Address - Street 2:
Practice Address - City:RIVIERA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33410-7417
Practice Address - Country:US
Practice Address - Phone:561-422-6267
Practice Address - Fax:561-422-5766
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND3972133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered