Lisa M. Fedderke, Midwife
Advanced Practice Midwife in Fort Wayne, IN. Individual provider (NPI-1).
NPI number1134530967
StatusActive
Last updated in NPPESJun 4, 2024
Details
- NPI
- 1134530967
- Entity type
- Individual (NPI-1)
- Name
- Lisa M. Fedderke
- Credential
- Midwife
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- May 14, 2014
- Certification date
- Jun 4, 2024
- Last updated
- Jun 4, 2024
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PRACTITIONER - CERTIFIED NURSE MIDWIFE (CNM)
- Can order and refer
- Part B Yes · DME Yes · Home health No · Power mobility No · Hospice No
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 367A00000X | Advanced Practice Midwife | 09000298 | IN | Yes |
| 367A00000X | Advanced Practice Midwife | 15865NM | OH |
Practice location
8028 Carnegie Blvd Ste 300Fort Wayne, IN 46804-5788
Phone 260-425-6650 · Fax 260-755-6233
Mailing address
11109 Parkview Plaza Dr # 117Fort Wayne, IN 46845-1701
Phone 260-266-6013
Other practice locations
442 W High St
Bryan, OH 43506-1681
Bryan, OH 43506-1681
Phone 419-636-4517 · Fax 419-636-6438
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This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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All 27 Advanced Practice Midwife providers in Fort Wayne · All 11,302 providers in Fort Wayne
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