Provider Demographics
NPI:1497341481
Name:ETZLER, SHIRLEY ANN
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:ANN
Last Name:ETZLER
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 1:15852 SCHUMM RD
Mailing Address - Street 2:
Mailing Address - City:WILLSHIRE
Mailing Address - State:OH
Mailing Address - Zip Code:45898-9833
Mailing Address - Country:US
Mailing Address - Phone:419-495-2081
Mailing Address - Fax:
Practice Address - Street 1:15852 SCHUMM RD
Practice Address - Street 2:
Practice Address - City:WILLSHIRE
Practice Address - State:OH
Practice Address - Zip Code:45898-9833
Practice Address - Country:US
Practice Address - Phone:419-495-2081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-15
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide