Healthcare Provider Details

I. General information

NPI: 1003369729
Provider Name (Legal Business Name): RUBY LEE FETT FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2016
Last Update Date: 08/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1391 W 5TH AVE STE 260
COLUMBUS OH
43212-2902
US

IV. Provider business mailing address

3233 CHADBOURNE RD
SHAKER HEIGHTS OH
44120-3378
US

V. Phone/Fax

Practice location:
  • Phone: 615-454-9850
  • Fax:
Mailing address:
  • Phone: 216-991-9770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.019642
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number329386
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: