Provider Demographics
NPI:1871560995
Name:FIEDLER, MARY R (NP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:R
Last Name:FIEDLER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8500 N ATLAS RD
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-8332
Mailing Address - Country:US
Mailing Address - Phone:208-415-5270
Mailing Address - Fax:208-415-5101
Practice Address - Street 1:1020 MICHIGAN ST
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-1788
Practice Address - Country:US
Practice Address - Phone:208-263-5159
Practice Address - Fax:208-263-6963
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP397A363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health