Provider Demographics
NPI:1659589901
Name:FELIX, TERESA LEN
Entity Type:Individual
Prefix:MISS
First Name:TERESA
Middle Name:LEN
Last Name:FELIX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N. PARK ST. LOT 6
Mailing Address - Street 2:
Mailing Address - City:FAYETTE
Mailing Address - State:OH
Mailing Address - Zip Code:43521
Mailing Address - Country:US
Mailing Address - Phone:419-237-2138
Mailing Address - Fax:
Practice Address - Street 1:400 N. PARK ST. LOT 6
Practice Address - Street 2:
Practice Address - City:FAYETTE
Practice Address - State:OH
Practice Address - Zip Code:43521
Practice Address - Country:US
Practice Address - Phone:419-237-2138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2454473OtherINDEPENDENT PROVIDER