Provider Demographics
NPI:1427781343
Name:DUCHARME, ETHAN (PA-C)
Entity type:Individual
Prefix:
First Name:ETHAN
Middle Name:
Last Name:DUCHARME
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 N BENT ST
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:WY
Mailing Address - Zip Code:82435-2712
Mailing Address - Country:US
Mailing Address - Phone:307-764-4107
Mailing Address - Fax:
Practice Address - Street 1:128 N BENT ST
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:WY
Practice Address - Zip Code:82435-2712
Practice Address - Country:US
Practice Address - Phone:307-764-4107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-07
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant