Provider Demographics
NPI:1598189870
Name:FEDOR, CATHY (RN)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:
Last Name:FEDOR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3199 DOBBINS RD
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44514-2327
Mailing Address - Country:US
Mailing Address - Phone:330-757-7018
Mailing Address - Fax:330-757-2305
Practice Address - Street 1:3199 DOBBINS RD
Practice Address - Street 2:
Practice Address - City:POLAND
Practice Address - State:OH
Practice Address - Zip Code:44514-2327
Practice Address - Country:US
Practice Address - Phone:330-757-7018
Practice Address - Fax:330-757-2305
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-07
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN157198163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool