Provider Demographics
NPI:1427530518
Name:FIDDELKE, KARALEE (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:KARALEE
Middle Name:
Last Name:FIDDELKE
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41750 CARTHAGE RD
Mailing Address - Street 2:PO BOX 8400
Mailing Address - City:RAVENNA
Mailing Address - State:NE
Mailing Address - Zip Code:68869
Mailing Address - Country:US
Mailing Address - Phone:308-452-3249
Mailing Address - Fax:308-452-3172
Practice Address - Street 1:41750 CARTHAGE RD
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:NE
Practice Address - Zip Code:68869-6886
Practice Address - Country:US
Practice Address - Phone:308-452-3249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE54980163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse