Provider Demographics
NPI:1073760971
Name:IWENJIORA, FELISHIA MICHELLE (RN)
Entity Type:Individual
Prefix:MS
First Name:FELISHIA
Middle Name:MICHELLE
Last Name:IWENJIORA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 E HENRIETTA RD APT D11
Mailing Address - Street 2:
Mailing Address - City:HENRIETTA
Mailing Address - State:NY
Mailing Address - Zip Code:14467-8945
Mailing Address - Country:US
Mailing Address - Phone:202-536-5217
Mailing Address - Fax:
Practice Address - Street 1:5000 E HENRIETTA RD APT D11
Practice Address - Street 2:
Practice Address - City:HENRIETTA
Practice Address - State:NY
Practice Address - Zip Code:14467-8945
Practice Address - Country:US
Practice Address - Phone:202-536-5217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-21
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY565539163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02857225Medicaid