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General NPI Number Information
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NPI Number | 1073523056
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Entity Type | Individual
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Provider Name | EDWINA RANDALL ZETTLER M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/09/2006
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Last Update Date | 11/05/2024
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Provider Practice Location Address
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Address Line | 2449 ROSS MILLVILLE RD ROSS MEDICAL CENTER, SUITE 252
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City | HAMILTON
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State | OH
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Zip | 45013-8951
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Country | US
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Telephone | 888-958-5830
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Fax | 888-433-6146
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Provider Business Mailing Address
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Address Line | 6259 CASEY CT
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City | FAIRFIELD
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State | OH
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Zip | 45014-3694
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Country | US
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Telephone | 513-829-7677
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 35.091084
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 39340
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License Number State | KY
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