Provider Demographics
NPI:1972542231
Name:FETZER, NATALIE KAY
Entity Type:Individual
Prefix:MISS
First Name:NATALIE
Middle Name:KAY
Last Name:FETZER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2506 1/2 BENTON AVE
Mailing Address - Street 2:APT B
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44312-1407
Mailing Address - Country:US
Mailing Address - Phone:330-328-2920
Mailing Address - Fax:
Practice Address - Street 1:2506 1/2 BENTON AVE
Practice Address - Street 2:APT B
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44312-1407
Practice Address - Country:US
Practice Address - Phone:330-328-2920
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2326361Medicaid