Provider Demographics
NPI:1063525616
Name:WETZEL, RALPH MERRILL (MDIV, STM, DMIN)
Entity type:Individual
Prefix:DR
First Name:RALPH
Middle Name:MERRILL
Last Name:WETZEL
Suffix:
Gender:M
Credentials:MDIV, STM, DMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4310 ARA DR
Mailing Address - Street 2:P.O. BOX 286
Mailing Address - City:WOODBURN
Mailing Address - State:IN
Mailing Address - Zip Code:46797-9588
Mailing Address - Country:US
Mailing Address - Phone:260-493-3695
Mailing Address - Fax:260-493-3322
Practice Address - Street 1:2121 LAKE AVE
Practice Address - Street 2:125-F
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-5100
Practice Address - Country:US
Practice Address - Phone:260-426-5431
Practice Address - Fax:260-460-1402
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered171W00000XOther Service ProvidersContractor
Not Answered174400000XOther Service ProvidersSpecialist
Not Answered101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN8934521762OtherDRIVER'S LICENSE
IN27105178OtherTPIN
INBRANDY432OtherMPIN
INP0500190OtherSBA
INXZMXZ3084733OtherBLUECROSS BLUE SHIELD
INP0500190OtherSBA