Provider Demographics
NPI:1699003061
Name:STALLWORTH, FELICIA (RN)
Entity Type:Individual
Prefix:
First Name:FELICIA
Middle Name:
Last Name:STALLWORTH
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 1:464 W 141ST ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10031-6202
Mailing Address - Country:US
Mailing Address - Phone:347-677-6422
Mailing Address - Fax:212-810-2890
Practice Address - Street 1:464 W 141ST ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10031-6202
Practice Address - Country:US
Practice Address - Phone:347-677-6422
Practice Address - Fax:212-810-2890
Is Sole Proprietor?:No
Enumeration Date:2009-11-24
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY419526-1163WG0000X, 163WM0705X, 163W00000X, 163WA2000X, 163WC0200X, 163WC3500X, 163WD0400X, 163WE0003X, 163WH0200X, 163WN0003X, 163WP0200X, 163WU0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No163W00000XNursing Service ProvidersRegistered Nurse
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No163WC3500XNursing Service ProvidersRegistered NurseCardiac Rehabilitation
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WN0003XNursing Service ProvidersRegistered NurseNeonatal, Low-Risk
No163WP0200XNursing Service ProvidersRegistered NursePediatrics
No163WU0100XNursing Service ProvidersRegistered NurseUrology