Healthcare Provider Details

I. General information

NPI: 1508638438
Provider Name (Legal Business Name): FELICIA UBER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2023
Last Update Date: 10/24/2023
Certification Date: 10/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

638 MAIN STREET
FERNDALE CA
95536
US

IV. Provider business mailing address

1275 8TH ST
ARCATA CA
95521-5770
US

V. Phone/Fax

Practice location:
  • Phone: 707-786-4025
  • Fax:
Mailing address:
  • Phone: 707-826-8633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number95282021
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: