Healthcare Provider Details

I. General information

NPI: 1649240482
Provider Name (Legal Business Name): LAUREL ANN FELCZER WHCNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 03/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1045 NORTH LAKE AVENUE
PASADENA CA
91104
US

IV. Provider business mailing address

1045 NORTH LAKE AVENUE
PASADENA CA
91104
US

V. Phone/Fax

Practice location:
  • Phone: 714-943-7162
  • Fax:
Mailing address:
  • Phone: 714-943-7162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License NumberRN 318164
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberNP6801
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: