Provider Demographics
NPI:1396112207
Name:ADDAE, FELICIA S (APRN)
Entity type:Individual
Prefix:
First Name:FELICIA
Middle Name:S
Last Name:ADDAE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:FELICIA
Other - Middle Name:S
Other - Last Name:OPOKU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:425 PLAINVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:UNIONVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06085-1419
Mailing Address - Country:US
Mailing Address - Phone:203-715-5246
Mailing Address - Fax:
Practice Address - Street 1:2639 MAIN ST
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-2023
Practice Address - Country:US
Practice Address - Phone:203-715-5246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-26
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6263363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily