Provider Demographics
NPI:1679548499
Name:FEDERSPIEL, BILLIE RAE (NP)
Entity type:Individual
Prefix:
First Name:BILLIE
Middle Name:RAE
Last Name:FEDERSPIEL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:BILLIE
Other - Middle Name:RAE
Other - Last Name:VINION
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1720 STONECREEK DR
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:MI
Mailing Address - Zip Code:49120-8686
Mailing Address - Country:US
Mailing Address - Phone:269-683-5745
Mailing Address - Fax:
Practice Address - Street 1:403 E MADISON ST
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46617-2322
Practice Address - Country:US
Practice Address - Phone:574-234-0061
Practice Address - Fax:574-283-1209
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000865A363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN955190CCMedicare ID - Type Unspecified
P08783Medicare UPIN