MEDICARE: NICHOLAS JAMES FETNER RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WE0003X	Emergency Registered Nurse	RN.RN.61303750	WA

General Provider Information

NPI Number	:	1649100058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS JAMES FETNER RN

Provider Business Mailing Address
First Line	:	16834 430TH LN SE
Second Line	:
City	:	NORTH BEND
State	:	WA
Zip	:	98045-9647
Country	:	US
Telephone Number	:	949-291-9553
Fax Number	:

Provider Business Practice Location Address
First Line	:	16834 430TH LN SE
Second Line	:
City	:	NORTH BEND
State	:	WA
Zip	:	98045-9647
Country	:	US
Telephone Number	:	949-291-9553
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2026
Last Update Date	:	05/20/2026

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