Provider Demographics
NPI:1932706694
Name:HETZER, MARIA EILEEN
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:EILEEN
Last Name:HETZER
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 1:1300 KANAWHA TER APT 5
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-3571
Mailing Address - Country:US
Mailing Address - Phone:702-498-4380
Mailing Address - Fax:
Practice Address - Street 1:1300 KANAWHA TER APT 5
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-3571
Practice Address - Country:US
Practice Address - Phone:702-498-4380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant