Provider Demographics
NPI:1679932313
Name:FRIERSON, FELICIA RENEE (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:FELICIA
Middle Name:RENEE
Last Name:FRIERSON
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:985 BURKE AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-3818
Mailing Address - Country:US
Mailing Address - Phone:347-219-2793
Mailing Address - Fax:
Practice Address - Street 1:985 BURKE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-3818
Practice Address - Country:US
Practice Address - Phone:347-219-2793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-22
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY467502163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse