MEDICARE: JOSHUA MARK FEGAN CRNA

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	367500000X	Certified Registered Nurse Anesthetist	00026352	OH

General Provider Information

NPI Number	:	1295207769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSHUA MARK FEGAN CRNA

Provider Business Mailing Address
First Line	:	1430 W MINER RD
Second Line	:
City	:	MAYFIELD HEIGHTS
State	:	OH
Zip	:	44124-1716
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13207 RAVENNA RD
Second Line	:
City	:	CHARDON
State	:	OH
Zip	:	44024-7032
Country	:	US
Telephone Number	:	440-285-6000
Fax Number	:

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

Provider Enumeration Date	:	12/21/2018
Last Update Date	:	12/05/2025

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