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Contact Information

KAITLIN ETZCORN, NP-C
5050 N CLINTON ST
FORT WAYNE, IN46825-5886
 Phone: 260-484-8551
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Family

363LF0000X 50 Nurse Practitioner
 

Orthopedic

163WX0800X
Indicates primary specialty

NPI Profile & details for KAITLIN ETZCORN · (Female)

NPI Number 1972106847
Status Active
Credentials NP-C (Nurse Practitioner - Certified)
Entity Individual
Enumeration date 11/20/2020
Last updated 08/13/2021 - About 5 years ago
Sole proprietor 1 No
Identifiers
  • IN License # 28197283A
  • IN License # 71011071A
Hospital affiliation(s)
  • PARKVIEW REGIONAL MEDICAL CENTER - (Acute Care)
    11109 PARKVIEW PLAZA DRIVE
    FORT WAYNE, IN 46845
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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