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General NPI Number Information
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NPI Number | 1962112896
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Entity Type | Individual
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Provider Name | CHARLOTTE GREGG FEDEROWICZ NP
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Gender | Female
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Dates
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Enumeration Date | 12/01/2022
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Last Update Date | 12/01/2022
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Provider Practice Location Address
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Address Line | 449 AMHERST ST
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City | NASHUA
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State | NH
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Zip | 03063-1209
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Country | US
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Telephone | 603-401-4884
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Fax |
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Provider Business Mailing Address
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Address Line | 3216 KNAPP RD
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City | VESTAL
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State | NY
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Zip | 13850-3015
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Country | US
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Telephone | 607-222-0128
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 090005-23
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License Number State | NH
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