Healthcare Provider Details

I. General information

NPI: 1063886620
Provider Name (Legal Business Name): NICOLE CATHERINE FEKETE-BRUNNER APRN BC FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NICOLE CATHERINE FEKETE APRN BC FNP

II. Dates (important events)

Enumeration Date: 11/19/2015
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 WEST MAIN STREET
ST. CLAIRSVILLE OH
43950
US

IV. Provider business mailing address

4850 EOFF ST
BENWOOD WV
26031-1008
US

V. Phone/Fax

Practice location:
  • Phone: 740-968-7006
  • Fax:
Mailing address:
  • Phone: 304-233-1656
  • Fax: 304-234-6749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number18414
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: