Provider Demographics
NPI:1720888381
Name:ETIENNE, MARIE WILTA
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:WILTA
Last Name:ETIENNE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 NE 7TH AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33483-5742
Mailing Address - Country:US
Mailing Address - Phone:754-465-6992
Mailing Address - Fax:
Practice Address - Street 1:701 NE 7TH AVE APT 5
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483-5742
Practice Address - Country:US
Practice Address - Phone:754-465-6992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-13
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4683374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide