Provider Demographics
NPI:1801267778
Name:FELICE, JAMIE (RN, LC)
Entity type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:
Last Name:FELICE
Suffix:
Gender:F
Credentials:RN, LC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2135 FRANKFORT ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-3412
Mailing Address - Country:US
Mailing Address - Phone:619-701-9441
Mailing Address - Fax:
Practice Address - Street 1:2135 FRANKFORT ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-3412
Practice Address - Country:US
Practice Address - Phone:619-701-9441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-16
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA822315163WL0100X, 163WM0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant