Provider Demographics
NPI:1194513887
Name:FEDELE, MEGHAN C (RN)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:C
Last Name:FEDELE
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 PERSHING ST
Mailing Address - Street 2:
Mailing Address - City:BOX ELDER
Mailing Address - State:SD
Mailing Address - Zip Code:57719-6004
Mailing Address - Country:US
Mailing Address - Phone:605-939-8145
Mailing Address - Fax:
Practice Address - Street 1:2165 PROMISE RD
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-8981
Practice Address - Country:US
Practice Address - Phone:605-718-1095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR053271163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse