Provider Demographics
NPI:1346223914
Name:FIEPKE, ROSALIND MARY (RN)
Entity type:Individual
Prefix:MRS
First Name:ROSALIND
Middle Name:MARY
Last Name:FIEPKE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8109 MILDRED RD
Mailing Address - Street 2:
Mailing Address - City:MACHESNEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61115-2535
Mailing Address - Country:US
Mailing Address - Phone:815-633-0930
Mailing Address - Fax:
Practice Address - Street 1:8109 MILDRED RD
Practice Address - Street 2:
Practice Address - City:MACHESNEY PARK
Practice Address - State:IL
Practice Address - Zip Code:61115-2535
Practice Address - Country:US
Practice Address - Phone:815-633-0930
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL163W00000X
WI163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38229300Medicaid