Provider Demographics
NPI:1336417435
Name:FIELDS, FELICIA JOYCE (AAT)
Entity Type:Individual
Prefix:MRS
First Name:FELICIA
Middle Name:JOYCE
Last Name:FIELDS
Suffix:
Gender:F
Credentials:AAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 MARWOOD ROAD EAST
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19120-2628
Mailing Address - Country:US
Mailing Address - Phone:215-457-1570
Mailing Address - Fax:
Practice Address - Street 1:540 MARWOOD ROAD EAST
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19120-2628
Practice Address - Country:US
Practice Address - Phone:215-457-1570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-05
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA171M00000X, 2278H0200X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No2278H0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedHome Health