Provider Demographics
NPI:1811576630
Name:HETZEL, LANA M (AGPC-CNP)
Entity Type:Individual
Prefix:
First Name:LANA
Middle Name:M
Last Name:HETZEL
Suffix:
Gender:F
Credentials:AGPC-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4870 PINNACLE WOODS DR
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-1430
Mailing Address - Country:US
Mailing Address - Phone:419-564-0734
Mailing Address - Fax:
Practice Address - Street 1:6275 EMERALD PKWY
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-3241
Practice Address - Country:US
Practice Address - Phone:614-792-5698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0027556363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner