Healthcare Provider Details

I. General information

NPI: 1427037290
Provider Name (Legal Business Name): CINDY K FEDDES FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 07/28/2023
Certification Date: 07/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1188 N 15TH AVE STE 3
BOZEMAN MT
59715-3290
US

IV. Provider business mailing address

1188 N 15TH AVE STE 3
BOZEMAN MT
59715-3290
US

V. Phone/Fax

Practice location:
  • Phone: 406-582-1111
  • Fax: 406-582-1112
Mailing address:
  • Phone: 406-582-1111
  • Fax: 406-582-1112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number28869
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: