Provider Demographics
NPI:1942654074
Name:HARRIS, FELICIA
Entity Type:Individual
Prefix:PROF
First Name:FELICIA
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:FDB HAIR
Other - Middle Name:
Other - Last Name:UNLIMITED LLC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2610 SAINT VINCENT AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63104-2028
Mailing Address - Country:US
Mailing Address - Phone:314-504-6466
Mailing Address - Fax:
Practice Address - Street 1:10096 PAGE BLVD
Practice Address - Street 2:
Practice Address - City:ST LOIUS
Practice Address - State:MO
Practice Address - Zip Code:63132
Practice Address - Country:US
Practice Address - Phone:314-504-6466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-14
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOLC0665509332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies