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General NPI Number Information
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NPI Number | 1841833720
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Entity Type | Individual
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Provider Name | RACHAEL E FEDAROVICH DNP
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Gender | Female
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Dates
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Enumeration Date | 10/23/2019
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Last Update Date | 10/23/2019
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Provider Practice Location Address
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Address Line | 684 FAIRVIEW RD
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City | SIMPSONVILLE
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State | SC
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Zip | 29680-6708
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Country | US
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Telephone | 864-372-3003
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Fax |
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Provider Business Mailing Address
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Address Line | 101 REEDY VIEW DR APT 308
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City | GREENVILLE
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State | SC
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Zip | 29601-1858
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 23181
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License Number State | SC
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