Healthcare Provider Details

I. General information

NPI: 1689849390
Provider Name (Legal Business Name): PATRICK JAMES FETTERS N.D., PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2008
Last Update Date: 05/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27445 DELLWOOD DR
WESTLAKE OH
44145-1354
US

IV. Provider business mailing address

231 LYME ST
BELLEVUE OH
44811-1421
US

V. Phone/Fax

Practice location:
  • Phone: 440-420-7064
  • Fax:
Mailing address:
  • Phone: 914-338-8377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207SG0205X
TaxonomyPh.D. Medical Genetics Physician
License Number85.1578658
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License NumberNT01563
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberNT01563
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: