Provider Demographics
NPI:1053830208
Name:FELIZ, EBONY (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:EBONY
Middle Name:
Last Name:FELIZ
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1545 CROSSWAYS BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-0218
Mailing Address - Country:US
Mailing Address - Phone:757-777-3667
Mailing Address - Fax:757-585-3418
Practice Address - Street 1:1545 CROSSWAYS BLVD.
Practice Address - Street 2:SUITE 250
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320
Practice Address - Country:US
Practice Address - Phone:757-777-3667
Practice Address - Fax:757-585-3418
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001271490171M00000X, 163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No171M00000XOther Service ProvidersCase Manager/Care Coordinator