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General NPI Number Information
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NPI Number | 1609915636
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Entity Type | Individual
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Provider Name | ADRIENE KIM FEDDE MD
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Gender | Female
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 06/22/2021
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Provider Practice Location Address
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Address Line | 103 FRAM STREET
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City | PETERSBURG
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State | AK
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Zip | 99833
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Country | US
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Telephone | 505-819-8996
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 150
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City | FRISCO
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State | CO
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Zip | 80443-0150
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Country | US
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Telephone | 505-819-8996
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Fax |
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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 | DR.0054942
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 7230
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License Number State | AK
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