Basic Information
| Provider Information | |||||||||
| NPI: | 1699373357 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ETTER | ||||||||
| FirstName: | DILLON | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | IN | ||||||||
| PostalCode: | 471021303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8127948100 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5515 W 38TH ST | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462542919 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178803838 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/15/2020 | ||||||||
| LastUpdateDate: | 11/24/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | N | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | 10003062A | IN | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.