Healthcare Provider Details

I. General information

NPI: 1174285787
Provider Name (Legal Business Name): NICHOLE FELDMAN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2021
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 MADISON AVE
FORT ATKINSON WI
53538-3100
US

IV. Provider business mailing address

PO BOX 249
FORT ATKINSON WI
53538-0249
US

V. Phone/Fax

Practice location:
  • Phone: 920-563-5500
  • Fax:
Mailing address:
  • Phone: 920-563-4466
  • Fax: 920-568-4004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number14634-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: