Provider Demographics
NPI:1336698422
Name:FELICIANO, CARMINA (LPN)
Entity Type:Individual
Prefix:
First Name:CARMINA
Middle Name:
Last Name:FELICIANO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:CARMINA
Other - Middle Name:
Other - Last Name:FELICIANO-THORNHILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:13036 THISTLE CT
Mailing Address - Street 2:
Mailing Address - City:HOMER GLEN
Mailing Address - State:IL
Mailing Address - Zip Code:60491-8703
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13036 THISTLE CT
Practice Address - Street 2:
Practice Address - City:HOMER GLEN
Practice Address - State:IL
Practice Address - Zip Code:60491-8703
Practice Address - Country:US
Practice Address - Phone:708-645-4580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-29
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL043.114329164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse