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Contact Information

MARK A VAN ETTEN
707 ASH ST
SPOONER, WI54801-1234
 Phone: 715-635-2151
 Fax: 715-635-8768
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Geriatric Medicine

207QG0300X 08 Physician/Family Practice
Indicates primary specialty

NPI Profile & details for MARK A VAN ETTEN · (Male)

NPI # 1568480614
Status Active
Credentials
Entity Individual
Enumeration date 07/17/2006
Last updated 05/09/2011 - About 15 years ago
Sole proprietor 1 No
Identifiers
  • WI License # 25178-020
  • WI Medicaid 30518900
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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