Organization
DRS. DETRICK & DETRICK INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CYNDEE J DETRICK (OFFICE MANAGER)
(419) 893-3316
Entity
Organization
Contact information
Practice address
5757 MONCLOVA ROAD, SUITE 14, MAUMEE, OH 43537
(419) 893-3316
Mailing address
5757 MONCLOVA ROAD, SUITE 14, MAUMEE, OH 43537
(419) 893-3316
Taxonomy
Speciality
Code
Description
License number
State
163WR0006X
Registered Nurse First Assistant
RN113039
OH
363LF0000X
Family Nurse Practitioner
Primary
032039822
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CB3101
MEDICARE RAILROAD
OH
Enumeration date
04/19/2007
Last updated
04/22/2008
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