Provider Demographics
NPI:1629370960
Name:MAYO, FELECIA WINIFRED (RN)
Entity Type:Individual
Prefix:MS
First Name:FELECIA
Middle Name:WINIFRED
Last Name:MAYO
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 1:4327 N 25TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-6655
Mailing Address - Country:US
Mailing Address - Phone:313-873-2468
Mailing Address - Fax:
Practice Address - Street 1:4327 N 25TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53209-6655
Practice Address - Country:US
Practice Address - Phone:414-873-2468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-18
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI109447163W00000X, 163WC0400X, 163WC1500X, 163WC1600X, 163WC2100X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development
No163WC2100XNursing Service ProvidersRegistered NurseContinence Care
No163WH0200XNursing Service ProvidersRegistered NurseHome Health