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General NPI Number Information
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NPI Number | 1396951901
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Entity Type | Individual
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Provider Name | LISA ANN FEDDERSEN R.N.
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Gender | Female
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1450 S DOBSON RD STE B324
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City | MESA
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State | AZ
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Zip | 85202-4712
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Country | US
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Telephone | 480-889-1573
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Fax | 480-889-1574
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Provider Business Mailing Address
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Address Line | 16824 N 51ST ST
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City | SCOTTSDALE
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State | AZ
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Zip | 85254-1065
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Country | US
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Telephone | 602-692-2722
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Fax | 480-889-1574
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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 | 163WA2000X
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Taxonomy Name | Administrator Registered Nurse
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License Number | RN133209
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License Number State | AZ
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