Provider Demographics
NPI:1033442405
Name:FEDLER, ANNETTE LYNN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:ANNETTE
Middle Name:LYNN
Last Name:FEDLER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2232 W 24TH ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811-3110
Mailing Address - Country:US
Mailing Address - Phone:218-390-8210
Mailing Address - Fax:218-726-1332
Practice Address - Street 1:2232 W 24TH ST
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811-3110
Practice Address - Country:US
Practice Address - Phone:218-390-8210
Practice Address - Fax:218-726-1332
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-16
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNL045383-5164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse