Provider Demographics
NPI:1689849390
Name:FETTERS, PATRICK JAMES (ND, PHD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:JAMES
Last Name:FETTERS
Suffix:
Gender:M
Credentials:ND, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 LYME ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:OH
Mailing Address - Zip Code:44811-1421
Mailing Address - Country:US
Mailing Address - Phone:914-338-8377
Mailing Address - Fax:
Practice Address - Street 1:27445 DELLWOOD DR
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-1354
Practice Address - Country:US
Practice Address - Phone:440-420-7064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-23
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY85.1578658207SG0205X
WANT015632083P0500X, 175F00000X
133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No207SG0205XAllopathic & Osteopathic PhysiciansMedical GeneticsPh.D. Medical Genetics
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic