Provider Demographics
NPI:1487171666
Name:ETIENNE, MANOTTE (RN, MSN, FNP-C)
Entity type:Individual
Prefix:
First Name:MANOTTE
Middle Name:
Last Name:ETIENNE
Suffix:
Gender:F
Credentials:RN, MSN, FNP-C
Other - Prefix:
Other - First Name:MANOTTE
Other - Middle Name:
Other - Last Name:MERCEDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:312 HARRISBURG ST
Mailing Address - Street 2:
Mailing Address - City:EAST BERLIN
Mailing Address - State:PA
Mailing Address - Zip Code:17316-9505
Mailing Address - Country:US
Mailing Address - Phone:717-259-0222
Mailing Address - Fax:
Practice Address - Street 1:312 HARRISBURG ST
Practice Address - Street 2:
Practice Address - City:EAST BERLIN
Practice Address - State:PA
Practice Address - Zip Code:17316
Practice Address - Country:US
Practice Address - Phone:717-259-0222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-28
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP017849363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily