Provider Demographics
NPI:1972195857
Name:THEDFORD, FAITH ROCHELLE (NP)
Entity Type:Individual
Prefix:MS
First Name:FAITH
Middle Name:ROCHELLE
Last Name:THEDFORD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1906 6TH AVE N
Mailing Address - Street 2:
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-3557
Mailing Address - Country:US
Mailing Address - Phone:515-227-1857
Mailing Address - Fax:
Practice Address - Street 1:1906 6TH AVE N
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-3557
Practice Address - Country:US
Practice Address - Phone:515-227-1857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-11
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAAG01210113363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care