Provider Demographics
NPI:1649609108
Name:FELICIANO, ELIZABETH (INDEPENDENT PROVIDER)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:FELICIANO
Suffix:
Gender:F
Credentials:INDEPENDENT PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9200 ORCHARD AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:OH
Mailing Address - Zip Code:44144-2555
Mailing Address - Country:US
Mailing Address - Phone:216-965-0061
Mailing Address - Fax:
Practice Address - Street 1:9200 ORCHARD AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:OH
Practice Address - Zip Code:44144-2555
Practice Address - Country:US
Practice Address - Phone:216-965-0061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-05
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401295310911376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1822228OtherDODD INDEPENDENT PROVIDER