Provider Demographics
NPI:1508860073
Name:FETZER, NANCY (CRNP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:FETZER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1086 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905-4305
Mailing Address - Country:US
Mailing Address - Phone:814-410-8300
Mailing Address - Fax:814-410-8331
Practice Address - Street 1:1111 FRANKLIN ST
Practice Address - Street 2:STE 300
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905-4330
Practice Address - Country:US
Practice Address - Phone:814-534-9230
Practice Address - Fax:814-534-9465
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP007073363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA066064Medicare ID - Type Unspecified
P78742Medicare UPIN