Provider Demographics
NPI:1710225321
Name:BOOSE, FELICIA
Entity Type:Individual
Prefix:
First Name:FELICIA
Middle Name:
Last Name:BOOSE
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 1:2955 W 29TH ST
Mailing Address - Street 2:#5C
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-2046
Mailing Address - Country:US
Mailing Address - Phone:646-644-8670
Mailing Address - Fax:347-587-3490
Practice Address - Street 1:2955 W 29TH ST
Practice Address - Street 2:#5C
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-2046
Practice Address - Country:US
Practice Address - Phone:646-644-8670
Practice Address - Fax:347-587-3490
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-17
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY247250-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse