Provider Demographics
NPI:1326283672
Name:FEDRAU, GIA M (RN)
Entity Type:Individual
Prefix:
First Name:GIA
Middle Name:M
Last Name:FEDRAU
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 ACONBURY DR
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-9355
Mailing Address - Country:US
Mailing Address - Phone:585-421-9355
Mailing Address - Fax:
Practice Address - Street 1:36 ACONBURY DR
Practice Address - Street 2:
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-9355
Practice Address - Country:US
Practice Address - Phone:585-421-9355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-15
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY500368-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse