Provider Demographics
NPI:1760119614
Name:FETZER, LANNETTE MARIE (CRNP, FNP-BC)
Entity Type:Individual
Prefix:
First Name:LANNETTE
Middle Name:MARIE
Last Name:FETZER
Suffix:
Gender:F
Credentials:CRNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4136 GREEN GATES LN
Mailing Address - Street 2:
Mailing Address - City:TYRONE
Mailing Address - State:PA
Mailing Address - Zip Code:16686-3032
Mailing Address - Country:US
Mailing Address - Phone:814-880-8506
Mailing Address - Fax:
Practice Address - Street 1:4136 GREEN GATES LN
Practice Address - Street 2:
Practice Address - City:TYRONE
Practice Address - State:PA
Practice Address - Zip Code:16686-3032
Practice Address - Country:US
Practice Address - Phone:
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP021432363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily