Healthcare Provider Details

I. General information

NPI: 1245797109
Provider Name (Legal Business Name): FELICIA WILSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2019
Last Update Date: 02/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

841 MOHAWK ST
BAKERSFIELD CA
93309-1506
US

IV. Provider business mailing address

841 MOHAWK ST
BAKERSFIELD CA
93309-1506
US

V. Phone/Fax

Practice location:
  • Phone: 661-323-8195
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number761219
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: