Provider Demographics
NPI:1174865521
Name:FEDEWA, EMILY (FNP-BC)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:FEDEWA
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:LIEBESKIND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:350 PARNASSUS AVE STE 404
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-3608
Mailing Address - Country:US
Mailing Address - Phone:206-450-7974
Mailing Address - Fax:
Practice Address - Street 1:350 PARNASSUS AVE STE 404
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-3608
Practice Address - Country:US
Practice Address - Phone:415-353-9088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-25
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60441782163W00000X
WAAP60462013363LF0000X
CA95010478363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse