Provider Demographics
NPI:1790804425
Name:EVERETT HATTER, FELICIA RENEE (LVN)
Entity Type:Individual
Prefix:MRS
First Name:FELICIA
Middle Name:RENEE
Last Name:EVERETT HATTER
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4760 SEPULVEDA BLVD
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-4820
Mailing Address - Country:US
Mailing Address - Phone:310-390-6612
Mailing Address - Fax:310-680-7062
Practice Address - Street 1:323 N PRAIRIE AVE STE 150
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-4503
Practice Address - Country:US
Practice Address - Phone:310-846-2100
Practice Address - Fax:310-680-7062
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN147972164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse