Healthcare Provider Details

I. General information

NPI: 1821354697
Provider Name (Legal Business Name): MARY MARTHA BELZ STNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2012
Last Update Date: 04/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4546 MARTINSBURG RD
NEWARK OH
43055-9644
US

IV. Provider business mailing address

PO BOX 8681
NEWARK OH
43058-8681
US

V. Phone/Fax

Practice location:
  • Phone: 740-366-5019
  • Fax:
Mailing address:
  • Phone: 740-258-8897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number376K00000X
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: