Individual
NICKOLAS FEDACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DNP, CRNA
Contact information
Practice address
5005 N. PIEDRAS ST., EL PASO, TX 79920-5001
(915) 742-1970
Mailing address
18511 HIGHLANDER MEDICS ST, FORT BLISS, TX 79906-5327
(915) 742-7777
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
RN.1638551
CO
367500000X
Certified Registered Nurse Anesthetist
Primary
1087313
TX
Other
Enumeration date
01/25/2021
Last updated
07/19/2023
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