Healthcare Provider Details

I. General information

NPI: 1962112896
Provider Name (Legal Business Name): CHARLOTTE GREGG FEDEROWICZ NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2022
Last Update Date: 12/01/2022
Certification Date: 11/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

449 AMHERST ST
NASHUA NH
03063-1209
US

IV. Provider business mailing address

3216 KNAPP RD
VESTAL NY
13850-3015
US

V. Phone/Fax

Practice location:
  • Phone: 603-401-4884
  • Fax:
Mailing address:
  • Phone: 607-222-0128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number090005-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: