Provider Demographics
NPI:1568197150
Name:FERDERER, JANELLE J (PHD)
Entity Type:Individual
Prefix:DR
First Name:JANELLE
Middle Name:J
Last Name:FERDERER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 SE 2ND ST
Mailing Address - Street 2:
Mailing Address - City:LINTON
Mailing Address - State:ND
Mailing Address - Zip Code:58552-7604
Mailing Address - Country:US
Mailing Address - Phone:701-851-0201
Mailing Address - Fax:
Practice Address - Street 1:203 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:LINTON
Practice Address - State:ND
Practice Address - Zip Code:58552-5855
Practice Address - Country:US
Practice Address - Phone:701-851-0201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND45000261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty