Provider Demographics
NPI:1841733680
Name:FEDOROV, KRISTIN GAI (SA-C)
Entity type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:GAI
Last Name:FEDOROV
Suffix:
Gender:F
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5015 DILLARD RD
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-4404
Mailing Address - Country:US
Mailing Address - Phone:541-999-0306
Mailing Address - Fax:
Practice Address - Street 1:5015 DILLARD RD
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-4404
Practice Address - Country:US
Practice Address - Phone:541-999-0306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-28
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant