Individual
DR. JENNIFER LYNN FEDOROFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4021 AVENUE B, SCOTTSBLUFF, NE 69361-4602
(503) 494-8211
Mailing address
901 PEACOCK DR, SCOTTSBLUFF, NE 69361-4901
(503) 545-6311
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
28521
NE
208000000X
Pediatrics Physician
PG163242
OR
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/31/2011
Last updated
10/19/2016
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