Provider Demographics
NPI:1588926059
Name:FETZER, REBECCA E
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:E
Last Name:FETZER
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 1:39 OLD GRANGE RD
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL JUNCTION
Mailing Address - State:NY
Mailing Address - Zip Code:12533-5804
Mailing Address - Country:US
Mailing Address - Phone:845-896-0924
Mailing Address - Fax:
Practice Address - Street 1:39 OLD GRANGE RD
Practice Address - Street 2:
Practice Address - City:HOPEWELL JUNCTION
Practice Address - State:NY
Practice Address - Zip Code:12533-5804
Practice Address - Country:US
Practice Address - Phone:845-896-0924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist