Individual
MR. DAVID J ETZEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CNP
Contact information
Practice address
31 E MAIN ST, SHELBY, OH 44875-1262
(419) 525-6795
(419) 525-6723
Mailing address
600 W. THIRD STREET, MANSFIELD, OH 44906-2633
(419) 522-6191
(419) 526-7939
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
12090-NP
OH
363LC1500X
Community Health Nurse Practitioner
12090-NP
OH
363LF0000X
Family Nurse Practitioner
Primary
NP12090
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12090-NP
STATE LICENSE
OH
05
—
3110449
—
OH
Enumeration date
01/11/2011
Last updated
05/26/2021
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