Active NPI
Carrie Jean Ettinger, CNS
- Nutritionist
- St. Michael's, MD
National Provider Identifier
1508584491
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nutritionist
- License
- DX5442
- Practice address
- 115 E Chew Ave
St Michaels, MD 21663 - Phone
- (301) 442-2315
- NPI assigned
- Aug 17, 2022
- Last updated
- Aug 17, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nutritionist | 133N00000X | DX5442 | MD | Primary |
Addresses
Primary practice location
115 E Chew Ave
St Michaels, MD 21663
Mailing address
PO Box 417
St Michaels, MD 21663-0417
Phone (301) 442-2315
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Certified Nurse Specialist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DX5442 | MD | MD | Nutritionist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1660694400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1660694400000",
"number": "1508584491",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 417",
"city": "ST MICHAELS",
"state": "MD",
"postal_code": "216630417",
"telephone_number": "301-442-2315"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "115 E CHEW AVE",
"city": "ST MICHAELS",
"state": "MD",
"postal_code": "21663",
"telephone_number": "301-442-2315"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ETTINGER",
"first_name": "CARRIE",
"middle_name": "JEAN",
"credential": "CNS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-08-17",
"last_updated": "2022-08-17",
"certification_date": "2022-08-15",
"status": "A"
},
"taxonomies": [
{
"code": "133N00000X",
"taxonomy_group": "",
"desc": "Nutritionist",
"state": "MD",
"license": "DX5442",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in St. Michael's, MD
- Choptank Community Health System, Inc. (St. Michael's Middle/High School SBHC)
- Kelly M Cooper
- Deborah C. Gootee CRNP-PMH, LLC
- Deck LLC (Medicine Shoppe Pharmacy)
- Gregory Dukes, CRNP
- Stephanie Rejeana Faulkner
- Stacy Ann Fox, PT
- Susan Marie Hagelman, CRNP PMHNP-BC
- Douglas Jon Hamsher, PA-C
- Megan Harmer, NP
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.