Individual
COURTNEY L. FEDOREK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4151 HENDERSON RD, HICKORY, PA 15340-1439
(724) 356-2273
(724) 356-2585
Mailing address
701 TECHNOLOGY DR STE 150, CANONSBURG, PA 15317-9531
(412) 531-2902
(412) 531-2948
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
MA055594
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0195236
—
OH
05
—
1031109670001
—
PA
01
—
288685RN0
MEDICARE
PA
Enumeration date
08/09/2012
Last updated
07/06/2023
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