Provider Demographics
NPI:1134984842
Name:FEHRENBACKER, MELISSA PHILLIPS (FNP-BC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:PHILLIPS
Last Name:FEHRENBACKER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1499 CURLEW DR
Mailing Address - Street 2:
Mailing Address - City:AMMON
Mailing Address - State:ID
Mailing Address - Zip Code:83406-4764
Mailing Address - Country:US
Mailing Address - Phone:208-227-3355
Mailing Address - Fax:208-529-6631
Practice Address - Street 1:1499 CURLEW DR
Practice Address - Street 2:
Practice Address - City:AMMON
Practice Address - State:ID
Practice Address - Zip Code:83406-4764
Practice Address - Country:US
Practice Address - Phone:208-227-3355
Practice Address - Fax:208-529-6631
Is Sole Proprietor?:No
Enumeration Date:2024-02-21
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID2023103921363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily