Provider Demographics
NPI:1558116822
Name:ERTEL, DAVID RAYMOND (DNP, FNP-C)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:RAYMOND
Last Name:ERTEL
Suffix:
Gender:M
Credentials:DNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4315 RUSSELL AVE
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44134-1852
Mailing Address - Country:US
Mailing Address - Phone:812-767-4047
Mailing Address - Fax:
Practice Address - Street 1:4315 RUSSELL AVE
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44134-1852
Practice Address - Country:US
Practice Address - Phone:812-767-4047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-20
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INF03240404363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily