Provider Demographics
NPI:1003369729
Name:FETT, RUBY LEE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:RUBY
Middle Name:LEE
Last Name:FETT
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3233 CHADBOURNE RD
Mailing Address - Street 2:
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44120-3378
Mailing Address - Country:US
Mailing Address - Phone:216-991-9770
Mailing Address - Fax:
Practice Address - Street 1:1391 W 5TH AVE
Practice Address - Street 2:STE 260
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43212-2902
Practice Address - Country:US
Practice Address - Phone:615-454-9850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-28
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.019642363LF0000X
OH329386163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse