Provider Demographics
NPI:1578172243
Name:MENDONCA, FELICIA (DNP)
Entity Type:Individual
Prefix:
First Name:FELICIA
Middle Name:
Last Name:MENDONCA
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 FAUNCE CORNER MALL RD
Mailing Address - Street 2:
Mailing Address - City:N DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02747-6216
Mailing Address - Country:US
Mailing Address - Phone:508-993-7601
Mailing Address - Fax:508-997-0523
Practice Address - Street 1:145 FAUNCE CORNER MALL RD
Practice Address - Street 2:
Practice Address - City:N DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-6216
Practice Address - Country:US
Practice Address - Phone:508-993-7601
Practice Address - Fax:508-997-0523
Is Sole Proprietor?:No
Enumeration Date:2020-07-28
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2019045342363LP2300X
MARN2279459363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2019045342Medicaid