Active NPI
Erin Nicole Etzel, PH.D.
- Clinical Psychologist
- Rio Rancho, NM
National Provider Identifier
1578016994
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 1435
- Practice address
- 4005 High Resort Blvd SE
Rio Rancho, NM 87124-5906 - Phone
- (505) 462-6000
- NPI assigned
- Aug 2, 2016
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 1435 | NM | Primary |
Addresses
Primary practice location
4005 High Resort Blvd SE
Rio Rancho, NM 87124-5906
Mailing address
4005 High Resort Blvd SE
Rio Rancho, NM 87124-5906
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 1, 2025 through Jan 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1435 | NM | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1470096000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1478736000000",
"number": "1578016994",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4005 HIGH RESORT BLVD SE",
"city": "RIO RANCHO",
"state": "NM",
"postal_code": "871245906"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4005 HIGH RESORT BLVD SE",
"city": "RIO RANCHO",
"state": "NM",
"postal_code": "871245906",
"telephone_number": "505-462-6000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ETZEL",
"first_name": "ERIN",
"middle_name": "NICOLE",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-08-02",
"last_updated": "2016-11-10",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NM",
"license": "1435",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rio Rancho, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.