Provider Demographics
NPI:1477224319
Name:FELICIANO, REINA (RN BSN)
Entity Type:Individual
Prefix:
First Name:REINA
Middle Name:
Last Name:FELICIANO
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2317 N SPAULDING AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-2519
Mailing Address - Country:US
Mailing Address - Phone:708-404-9476
Mailing Address - Fax:
Practice Address - Street 1:4900 N BERNARD ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-5146
Practice Address - Country:US
Practice Address - Phone:773-583-7130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041349438163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse