Provider Demographics
NPI:1881999555
Name:ETZEL, DAVID J (CNP)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:J
Last Name:ETZEL
Suffix:
Gender:M
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 W. THIRD STREET
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44906-2633
Mailing Address - Country:US
Mailing Address - Phone:419-522-6191
Mailing Address - Fax:419-526-7939
Practice Address - Street 1:31 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:OH
Practice Address - Zip Code:44875-1262
Practice Address - Country:US
Practice Address - Phone:419-525-6795
Practice Address - Fax:419-525-6723
Is Sole Proprietor?:No
Enumeration Date:2011-01-11
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH12090-NP363L00000X, 363LC1500X
OHNP12090363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH12090-NPOtherSTATE LICENSE
OH3110449Medicaid
OH3110449Medicaid