Doctor Name: | CHASIDY FEDEROFF |
NPI Number: | 1093118770 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 4704277497 |
Business Practice Address: | 2280 E Grand River Ave Howell, MI - 488438503 |
Business Phone Number: | 5175464126 |
Business Fax Number: | 5175461300 |
Mailing Address: | 2280 E Grand River Ave, HOWELL |
State: | MI |
Postal Code: | 488438503 |
Phone Number: | 5175464126 |
Fax Number: | 5175461300 |
NPI Enumeration Date: | 10/08/2014 |
NPI Last Update Date: | 10/08/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 163WC1500X |
License Number: | 4704277497 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Nursing Service Providers |
Taxonomy Classification: | Registered Nurse |
Taxonomy Specialization: | Community Health |
Taxonomy Definition: |