Individual
NICOLE MARIE FETZER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
225 GREENFIELD PKWY STE 105, LIVERPOOL, NY 13088
(315) 451-6911
(315) 451-1540
Mailing address
PO BOX 2337, SYRACUSE, NY 13220-2337
(315) 422-6705
(315) 422-3909
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
543801
NY
367500000X
Certified Registered Nurse Anesthetist
Primary
543801
NY
Other
Enumeration date
03/25/2011
Last updated
07/22/2023
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