Individual
JESSICA M FETTERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
4282 TROUT LILLY LN, MANLIUS, NY 13104-9807
(315) 877-2402
Mailing address
4282 TROUT LILLY LN, MANLIUS, NY 13104-9807
(315) 877-2402
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
5601004474
MI
363AM0700X
Medical Physician Assistant
Primary
—
NY
Other
Enumeration date
11/02/2006
Last updated
09/07/2010
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