Provider Demographics
NPI:1770238552
Name:ALSTORK, FELICIA LATORIA (RN)
Entity Type:Individual
Prefix:
First Name:FELICIA
Middle Name:LATORIA
Last Name:ALSTORK
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 1:4911 W GOOD HOPE RD STE 103
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53223-4840
Mailing Address - Country:US
Mailing Address - Phone:414-885-3709
Mailing Address - Fax:414-376-4716
Practice Address - Street 1:4911 W GOOD HOPE RD STE 103
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53223-4840
Practice Address - Country:US
Practice Address - Phone:414-885-3709
Practice Address - Fax:414-306-6426
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-19
Last Update Date:2022-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center