Healthcare Provider Details

I. General information

NPI: 1215441035
Provider Name (Legal Business Name): SANDRA BRIGITTE FEDIE MSN, RN, FNP, WCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2017
Last Update Date: 02/26/2020
Certification Date: 02/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6036 N 19TH AVE STE 204
PHOENIX AZ
85015-2104
US

IV. Provider business mailing address

PO BOX 1117
HIGLEY AZ
85236-1117
US

V. Phone/Fax

Practice location:
  • Phone: 480-292-8542
  • Fax: 480-616-0603
Mailing address:
  • Phone: 480-626-1746
  • Fax: 480-626-2690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN124457
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number2131120
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberTAP10885
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: