Provider Demographics
NPI:1083345805
Name:FETRO, LEA MARIE
Entity Type:Individual
Prefix:
First Name:LEA
Middle Name:MARIE
Last Name:FETRO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9321 COUNTY ROAD 59
Mailing Address - Street 2:
Mailing Address - City:CAREY
Mailing Address - State:OH
Mailing Address - Zip Code:43316-9615
Mailing Address - Country:US
Mailing Address - Phone:419-208-8836
Mailing Address - Fax:
Practice Address - Street 1:9321 COUNTY ROAD 59
Practice Address - Street 2:
Practice Address - City:CAREY
Practice Address - State:OH
Practice Address - Zip Code:43316-9615
Practice Address - Country:US
Practice Address - Phone:419-208-8836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-22
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker