MEDICARE: LORA A FETTERMAN RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN209981	OH

General Provider Information

NPI Number	:	1124974035
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORA A FETTERMAN RN

Provider Business Mailing Address
First Line	:	24580 BRIARWOOD DR
Second Line	:
City	:	OLMSTED FALLS
State	:	OH
Zip	:	44138-2802
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2001 CROCKER RD STE 600
Second Line	:
City	:	WESTLAKE
State	:	OH
Zip	:	44145-6954
Country	:	US
Telephone Number	:	440-871-5100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/05/2026
Last Update Date	:	03/05/2026

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