Individual provider · NPI-1

Michael C Etheredge II, IDMT

Military Health Care Provider, Independent Duty Medical Technicians · Langley Afb, VA

NPI number1639729106
StatusActive
Last updated in NPPESSep 17, 2019

Details

NPI
1639729106
Entity type
Individual (NPI-1)
Name
Mr. Michael C Etheredge II
Credential
IDMT
Sex
Male
Sole proprietor
No
Enumeration date
Sep 17, 2019
Last updated
Sep 17, 2019

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
1710I1003X Military Health Care Provider, Independent Duty Medical Technicians––Yes

Practice location

77 Nealy Ave
Langley Afb, VA 23665-2040

Phone 757-764-6800

Mailing address

77 Nealy Ave
Langley Afb, VA 23665-2040

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