Individual
NICOLA ANNE FEDOROWICZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3400 SPRUCE ST, 6 DULLES, PHILADELPHIA, PA 19104-4238
(215) 662-4000
Mailing address
3400 SPRUCE ST, 6 DULLES, PHILADELPHIA, PA 19104-4238
(215) 662-4000
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
MA060885
PA
363AM0700X
Medical Physician Assistant
—
—
Other
Enumeration date
08/08/2019
Last updated
09/04/2019
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