NPI 1760577902

Sandra Lynn Ettema, MDPHD

Practitioner Otolaryngology Physician Mattoon, IL

Practice location

Address: 1005 Health Center Dr STE 201, Mattoon, IL 61938-4653
Phone: (217) 258-2409
Fax: (217) 258-2323
Mailing address: PO Box 372, Mattoon, IL 61938-0372

Registered specialties

Otolaryngology Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 207Y00000X Licence 036.118460 (IL)

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Registry record

NPI: 1760577902
Entity type: Individual
Sex (as registered): Female
NPI issued: 4 Oct 2006
Record last updated: 8 Nov 2024

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.