Provider Demographics
NPI:1750798864
Name:METZGAR, MINDY
Entity type:Individual
Prefix:
First Name:MINDY
Middle Name:
Last Name:METZGAR
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 1:4000 ZINK DR NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2736
Mailing Address - Country:US
Mailing Address - Phone:330-224-1795
Mailing Address - Fax:
Practice Address - Street 1:4000 ZINK DR NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2736
Practice Address - Country:US
Practice Address - Phone:330-224-1795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-21
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2738596Medicaid