Provider Demographics
NPI:1962112896
Name:FEDEROWICZ, CHARLOTTE GREGG (NP)
Entity type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:GREGG
Last Name:FEDEROWICZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3216 KNAPP RD
Mailing Address - Street 2:
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-3015
Mailing Address - Country:US
Mailing Address - Phone:607-222-0128
Mailing Address - Fax:
Practice Address - Street 1:449 AMHERST ST
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03063-1209
Practice Address - Country:US
Practice Address - Phone:603-401-4884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-01
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH090005-23363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily