Individual
JILLIAN TAIT FETZNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
10685 CARNEGIE AVE, CLEVELAND, OH 44106
(216) 445-7634
(216) 444-3474
Mailing address
10685 CARNEGIE AVE, CLEVELAND, OH 44106
(216) 445-7634
(216) 444-3474
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
COA16124
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0115025
—
OH
Enumeration date
11/05/2014
Last updated
02/15/2019
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