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General NPI Number Information
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NPI Number | 1497757736
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Entity Type | Individual
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Provider Name | KRISELL D FEDRIZZI D.O.
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Gender | Female
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Dates
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Enumeration Date | 06/01/2005
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Last Update Date | 07/03/2024
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Provider Practice Location Address
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Address Line | 325 N MAIN ST STE 206
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City | SPRINGBORO
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State | OH
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Zip | 45066-8005
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Country | US
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Telephone | 937-949-4713
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Fax | 855-460-5802
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Provider Business Mailing Address
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Address Line | PO BOX 194
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City | SPRINGBORO
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State | OH
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Zip | 45066-0194
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Country | US
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Telephone | 937-949-4713
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Fax | 855-460-5802
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 34004949F
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License Number State | OH
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