Provider Demographics
NPI:1508046186
Name:SHEVETZ, DAVID A (RN)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:A
Last Name:SHEVETZ
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 MEADOWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44514-3291
Mailing Address - Country:US
Mailing Address - Phone:330-770-4320
Mailing Address - Fax:330-707-9095
Practice Address - Street 1:1340 MEADOWOOD CIR
Practice Address - Street 2:
Practice Address - City:POLAND
Practice Address - State:OH
Practice Address - Zip Code:44514-3291
Practice Address - Country:US
Practice Address - Phone:330-770-4320
Practice Address - Fax:330-707-9095
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-12
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN-169204163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse