Provider Demographics
NPI:1285058677
Name:BERTZ, CATHY
Entity type:Individual
Prefix:
First Name:CATHY
Middle Name:
Last Name:BERTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 BRIARHEATH AVE
Mailing Address - Street 2:
Mailing Address - City:NAPOLEON
Mailing Address - State:OH
Mailing Address - Zip Code:43545-1251
Mailing Address - Country:US
Mailing Address - Phone:419-599-1050
Mailing Address - Fax:419-599-8537
Practice Address - Street 1:701 BRIARHEATH AVE
Practice Address - Street 2:
Practice Address - City:NAPOLEON
Practice Address - State:OH
Practice Address - Zip Code:43545-1251
Practice Address - Country:US
Practice Address - Phone:419-599-1050
Practice Address - Fax:419-599-8537
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-06
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.060369164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse