Provider Demographics
NPI:1033552906
Name:FUGATE, FELICIA RENEE (LPN)
Entity Type:Individual
Prefix:
First Name:FELICIA
Middle Name:RENEE
Last Name:FUGATE
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 1:4607 BELCOURT DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45417-6103
Mailing Address - Country:US
Mailing Address - Phone:937-267-4238
Mailing Address - Fax:
Practice Address - Street 1:4607 BELCOURT DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417-6103
Practice Address - Country:US
Practice Address - Phone:937-267-4238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-10
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH145333164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse