1770821167 NPI number — MRS. CAROL MICHALE FETZIK BSN,OMT

Table of content: MRS. CAROL MICHALE FETZIK BSN,OMT (NPI 1770821167)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770821167 NPI number — MRS. CAROL MICHALE FETZIK BSN,OMT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FETZIK
Provider First Name:
CAROL
Provider Middle Name:
MICHALE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
BSN,OMT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770821167
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/21/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2548 N MAIZE CT
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
WICHITA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67205-7347
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
316-706-7623
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2548 N MAIZE CT
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
WICHITA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67205-7347
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-706-7623
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/21/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com