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General NPI Number Information
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NPI Number | 1215441035
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Entity Type | Individual
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Provider Name | SANDRA BRIGITTE FEDIE MSN, RN, FNP, WCC
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Gender | Female
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Dates
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Enumeration Date | 12/01/2017
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Last Update Date | 02/26/2020
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Provider Practice Location Address
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Address Line | 6036 N 19TH AVE STE 204
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City | PHOENIX
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State | AZ
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Zip | 85015-2104
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Country | US
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Telephone | 480-292-8542
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Fax | 480-616-0603
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Provider Business Mailing Address
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Address Line | PO BOX 1117
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City | HIGLEY
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State | AZ
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Zip | 85236-1117
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Country | US
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Telephone | 480-626-1746
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Fax | 480-626-2690
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number | RN124457
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 163WW0000X
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Taxonomy Name | Wound Care Registered Nurse
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License Number | 2131120
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | TAP10885
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License Number State | AZ
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