Provider Demographics
NPI:1215441035
Name:FEDIE, SANDRA BRIGITTE (MSN, RN, FNP, WCC)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:BRIGITTE
Last Name:FEDIE
Suffix:
Gender:F
Credentials:MSN, RN, FNP, WCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1117
Mailing Address - Street 2:
Mailing Address - City:HIGLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85236-1117
Mailing Address - Country:US
Mailing Address - Phone:480-626-1746
Mailing Address - Fax:480-626-2690
Practice Address - Street 1:6036 N 19TH AVE STE 204
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-2104
Practice Address - Country:US
Practice Address - Phone:480-292-8542
Practice Address - Fax:480-616-0603
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-01
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN124457163WG0000X
AZ2131120163WW0000X
AZTAP10885363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WW0000XNursing Service ProvidersRegistered NurseWound Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAP10885OtherLICENSE