Mary Margaret Fedewa, CRNP CNS

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

4704149241 Issued in MI

Practice address

3263 W Chadwick Rd
Dewitt, MI 48820-9194

Phone

(517) 899-0816

NPI assigned

Oct 20, 2012

Last updated

Oct 20, 2012By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1350691200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1350691200000",
    "number": "1659624138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "NIH 10 CENTER DR",
            "city": "BETHESDA",
            "state": "MD",
            "postal_code": "208940001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3263 W CHADWICK RD",
            "city": "DEWITT",
            "state": "MI",
            "postal_code": "488209194",
            "telephone_number": "517-899-0816"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FEDEWA",
        "first_name": "MARY",
        "middle_name": "MARGARET",
        "name_prefix": "Ms.",
        "credential": "CRNP  CNS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-10-20",
        "last_updated": "2012-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MI",
            "license": "4704149241",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "15347",
            "primary": false
        },
        {
            "code": "364S00000X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist",
            "state": "CA",
            "license": "2258",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Julia Drake, PT, DPT
• Jackie Drushel-Vanamburg, RDH
• Larson Pax Drzewicki, MA, CCC-SLP
• Edward W. Sparrow Hospital Association (Sparrow Medical Group DeWitt)
• David Joseph Fedewa, D.M.D.
• Jana Marie Fisher, O.D.
• Emily Anne Fritz
• Jaren Marie Pickens Gebhard, PT
• Jason Michael Gilliam, LMSW
• Kaylea Sayle Goerge-Flowers

• Nurse Practitioner in Dewitt, MI
• Providers in Dewitt, MI by specialty
• Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.