| Doctor Name: | ELIZABETH FEDDERSEN |
| NPI Number: | 1699142737 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP-S |
| License Number: | 083037662RN |
| Business Practice Address: | 1024 Sw 12th St Troutdale, OR - 970601498 |
| Business Phone Number: | 5038132000 |
| Business Fax Number: | |
| Mailing Address: | 1024 Sw 12th St, TROUTDALE |
| State: | OR |
| Postal Code: | 970601498 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 08/24/2015 |
| NPI Last Update Date: | 08/24/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 302R00000X |
| License Number: | 083037662RN |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | OR |
| Taxonomy Type: | Managed Care Organizations |
| Taxonomy Classification: | Health Maintenance Organization |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) A form of health insurance in which its members prepay a premium for the HMO |