Provider Demographics
NPI:1225371388
Name:FEDERSPIEL, MARY CLAYTON (CPNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:CLAYTON
Last Name:FEDERSPIEL
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1127 VERMILLION DR.
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713
Mailing Address - Country:US
Mailing Address - Phone:919-338-2568
Mailing Address - Fax:
Practice Address - Street 1:PEDIATRIC CARDIOLOGY 101 MANNING DR
Practice Address - Street 2:ROOM MG 140, CB#7232
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-7232
Practice Address - Country:US
Practice Address - Phone:919-966-4601
Practice Address - Fax:919-966-6894
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-27
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC5006117363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics