Provider Demographics
NPI:1326713389
Name:FEDDIMAN, LISA INEZ (HOME HEALTH AIDE)
Entity Type:Individual
Prefix:MISS
First Name:LISA
Middle Name:INEZ
Last Name:FEDDIMAN
Suffix:
Gender:F
Credentials:HOME HEALTH AIDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6651 SHARPTOWN RD
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:DE
Mailing Address - Zip Code:19956-4147
Mailing Address - Country:US
Mailing Address - Phone:302-604-1058
Mailing Address - Fax:
Practice Address - Street 1:6651 SHARPTOWN RD
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:DE
Practice Address - Zip Code:19956-4147
Practice Address - Country:US
Practice Address - Phone:302-604-1058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-11
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide