1356467542 NPI number — SUSAN G FETZER M.S., R.D.N., L.D.N.

Table of content: APRIL FORD (NPI 1205545829)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356467542 NPI number — SUSAN G FETZER M.S., R.D.N., L.D.N.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FETZER
Provider First Name:
SUSAN
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.S., R.D.N., L.D.N.
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:
1356467542
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/26/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3500 ARENDELL ST
Provider Second Line Business Mailing Address:
CARTERET GENERAL HOSPITAL
Provider Business Mailing Address City Name:
MOREHEAD CITY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28557-2901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-808-6115
Provider Business Mailing Address Fax Number:
808-808-6920

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3500 ARENDELL ST
Provider Second Line Business Practice Location Address:
CARTERET GENERAL HOSPITAL
Provider Business Practice Location Address City Name:
MOREHEAD CITY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28557-2901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-808-6115
Provider Business Practice Location Address Fax Number:
808-808-6920
Provider Enumeration Date:
03/21/2007

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: 133V00000X , with the licence number:  L000680 , registered in the state of NC ; 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