Provider Demographics
NPI:1942724166
Name:EDMONDS, FELECIA ANNE (RN)
Entity Type:Individual
Prefix:
First Name:FELECIA
Middle Name:ANNE
Last Name:EDMONDS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:FELECIA
Other - Middle Name:ANNE
Other - Last Name:KETTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:351 LADWIG ST
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLSPORT
Mailing Address - State:WI
Mailing Address - Zip Code:53010-2759
Mailing Address - Country:US
Mailing Address - Phone:920-918-2391
Mailing Address - Fax:
Practice Address - Street 1:351 LADWIG ST
Practice Address - Street 2:
Practice Address - City:CAMPBELLSPORT
Practice Address - State:WI
Practice Address - Zip Code:53010-2759
Practice Address - Country:US
Practice Address - Phone:920-918-2391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI237225163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse