Provider Demographics
NPI:1407257488
Name:FEDELE, NICOLE (ARNP)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:FEDELE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:563-355-7733
Mailing Address - Fax:563-355-9077
Practice Address - Street 1:1351 KIMBERLY RD STE 100
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-4193
Practice Address - Country:US
Practice Address - Phone:563-355-7733
Practice Address - Fax:563-355-9077
Is Sole Proprietor?:No
Enumeration Date:2014-09-10
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.011784363LA2100X
IAH096495363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care