Provider Demographics
NPI:1033692009
Name:AGYEMANG WIREDU, FELICIA ABENA (LICENSE NURSE)
Entity Type:Individual
Prefix:
First Name:FELICIA
Middle Name:ABENA
Last Name:AGYEMANG WIREDU
Suffix:
Gender:F
Credentials:LICENSE NURSE
Other - Prefix:
Other - First Name:FELICIA
Other - Middle Name:
Other - Last Name:AGYEMANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICENSE NURSE
Mailing Address - Street 1:350 SHADY OAK DR
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-5943
Mailing Address - Country:US
Mailing Address - Phone:951-858-8164
Mailing Address - Fax:951-278-1251
Practice Address - Street 1:350 SHADY OAK DR
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-5943
Practice Address - Country:US
Practice Address - Phone:951-858-8164
Practice Address - Fax:951-278-1251
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-14
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA684625164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse