Provider Demographics
NPI:1932897352
Name:FATZINGER, BROOKE
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:FATZINGER
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 1:4360 EGYPT RD
Mailing Address - Street 2:
Mailing Address - City:SMITHVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44677-9530
Mailing Address - Country:US
Mailing Address - Phone:330-347-8934
Mailing Address - Fax:
Practice Address - Street 1:4360 EGYPT RD
Practice Address - Street 2:
Practice Address - City:SMITHVILLE
Practice Address - State:OH
Practice Address - Zip Code:44677-9530
Practice Address - Country:US
Practice Address - Phone:330-347-8934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-25
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No376J00000XNursing Service Related ProvidersHomemaker
No385H00000XRespite Care FacilityRespite Care