Provider Demographics
NPI:1902049224
Name:HALL, FELICIA DENISE (LPN)
Entity Type:Individual
Prefix:
First Name:FELICIA
Middle Name:DENISE
Last Name:HALL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4308 CULLEN DR
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44105-7221
Mailing Address - Country:US
Mailing Address - Phone:216-441-6461
Mailing Address - Fax:
Practice Address - Street 1:4308 CULLEN DR
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44105-7221
Practice Address - Country:US
Practice Address - Phone:216-441-6461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-16
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN124803164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse