Provider Demographics
NPI:1043916497
Name:FEUDO, RAINA MAE ELPEDES (NP)
Entity Type:Individual
Prefix:
First Name:RAINA MAE
Middle Name:ELPEDES
Last Name:FEUDO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:RAINA MAE
Other - Middle Name:
Other - Last Name:FEUDO-WITKOWSKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:2430 W RAY RD STE 3
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-3552
Mailing Address - Country:US
Mailing Address - Phone:480-626-6318
Mailing Address - Fax:
Practice Address - Street 1:2430 W RAY RD STE 3
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-3552
Practice Address - Country:US
Practice Address - Phone:480-626-6318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ285540363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily