Provider Demographics
NPI:1407440571
Name:SWARTZENTRUBER, TERETTA (STNA)
Entity Type:Individual
Prefix:
First Name:TERETTA
Middle Name:
Last Name:SWARTZENTRUBER
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 E HENRY ST APT G
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-4292
Mailing Address - Country:US
Mailing Address - Phone:330-988-3875
Mailing Address - Fax:
Practice Address - Street 1:710 E HENRY ST APT G
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-4292
Practice Address - Country:US
Practice Address - Phone:330-988-3875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-01
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH602266730920251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH602266730920OtherSTNA