# CAROLYN R FEGENBUSH

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1629009790
- **Gender:** F
- **Credential:** ARNP

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QA0401X | Addiction Medicine (Family Medicine) Physician | 71001579A | IN | — |
| 363L00000X | Nurse Practitioner | 71001579A | IN | Yes |

## Other

- **Enumeration date:** 07/06/2006
- **Last updated:** 11/08/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 200451720 | — | IN |
| 01 | — | 2823492000 | PASSPORT ADVANTAGE | — |
| 01 | — | 50014111 | PASSPORT | — |
| 05 | — | 78010824 | — | KY |
| 01 | — | P00424435 | RAILROAD MEDICARE | — |