Healthcare Provider Details

I. General information

NPI: 1598189870
Provider Name (Legal Business Name): CATHY FEDOR RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2014
Last Update Date: 02/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3199 DOBBINS RD
POLAND OH
44514-2327
US

IV. Provider business mailing address

3199 DOBBINS RD
POLAND OH
44514-2327
US

V. Phone/Fax

Practice location:
  • Phone: 330-757-7018
  • Fax: 330-757-2305
Mailing address:
  • Phone: 330-757-7018
  • Fax: 330-757-2305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN157198
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: