Provider Demographics
NPI:1407184096
Name:FAUNTLEROY, FELICIA C (RN)
Entity Type:Individual
Prefix:MS
First Name:FELICIA
Middle Name:C
Last Name:FAUNTLEROY
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 1:4007 ROSECREST AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-3428
Mailing Address - Country:US
Mailing Address - Phone:443-506-6110
Mailing Address - Fax:410-585-1549
Practice Address - Street 1:4007 ROSECREST AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-3428
Practice Address - Country:US
Practice Address - Phone:443-506-6110
Practice Address - Fax:410-585-1549
Is Sole Proprietor?:No
Enumeration Date:2009-11-19
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR187622163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse