Healthcare Provider Details

I. General information

NPI: 1629663935
Provider Name (Legal Business Name): CHANTELLE ALICE LOU FIEBER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2021
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S BRUCE ST
MARSHALL MN
56258-1934
US

IV. Provider business mailing address

PO BOX 89
GOODWIN SD
57238-0089
US

V. Phone/Fax

Practice location:
  • Phone: 507-537-9300
  • Fax:
Mailing address:
  • Phone: 605-881-3217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCP001977
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: