Provider Demographics
NPI:1699006627
Name:LASSITER, FELICIA (RN)
Entity Type:Individual
Prefix:
First Name:FELICIA
Middle Name:
Last Name:LASSITER
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 1:21 HAMPTON RD
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-5657
Mailing Address - Country:US
Mailing Address - Phone:845-214-3112
Mailing Address - Fax:
Practice Address - Street 1:6 PICNIC WOODS RD
Practice Address - Street 2:
Practice Address - City:CLINTONDALE
Practice Address - State:NY
Practice Address - Zip Code:12515-5104
Practice Address - Country:US
Practice Address - Phone:845-883-7579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-14
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5549271163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse