Individual
DR. ANNA VLADIMIROVNA FEDOTOVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2050 A SECOND STREET SE, KIRTLAND AFB, NM 87117-5546
(505) 846-3305
Mailing address
2050A 2ND ST SE, KIRTLAND AFB, NM 87117-5522
(505) 846-3305
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
6933
OH
103TB0200X
Cognitive & Behavioral Psychologist
Primary
—
—
Other
Enumeration date
09/16/2010
Last updated
09/02/2021
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