Provider Demographics
NPI:1770821167
Name:FETZIK, CAROL MICHALE (BSN,OMT)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:MICHALE
Last Name:FETZIK
Suffix:
Gender:F
Credentials:BSN,OMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2548 N MAIZE CT
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205-7347
Mailing Address - Country:US
Mailing Address - Phone:316-706-7623
Mailing Address - Fax:
Practice Address - Street 1:2548 N MAIZE CT
Practice Address - Street 2:SUITE 100
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205-7347
Practice Address - Country:US
Practice Address - Phone:316-706-7623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-21
Last Update Date:2013-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist