Individual
CHERYL ANN FEDELE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
250 BON AIR RD UNIT B, GREENBRAE, CA 94904-1702
(415) 473-6666
(415) 473-4113
Mailing address
8800 CIDER SPRINGS RD, SEBASTOPOL, CA 95472-2565
(978) 835-7684
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
95112363
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Y4569552
DRIVERS LICENSE
CA
Enumeration date
08/29/2017
Last updated
08/29/2017
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