1063886620 NPI number — MISS NICOLE CATHERINE FEKETE APRN BC FNP

Table of content: MISS NICOLE CATHERINE FEKETE APRN BC FNP (NPI 1063886620)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063886620 NPI number — MISS NICOLE CATHERINE FEKETE APRN BC FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FEKETE
Provider First Name:
NICOLE
Provider Middle Name:
CATHERINE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
APRN BC FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063886620
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/03/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4850 EOFF ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BENWOOD
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26031-1008
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-233-1656
Provider Business Mailing Address Fax Number:
304-234-6749

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
302 WEST MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST. CLAIRSVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43950
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-968-7006
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/19/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  18414 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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