Healthcare Provider Details

I. General information

NPI: 1124408984
Provider Name (Legal Business Name): GLORIA FELLING REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2015
Last Update Date: 06/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 STONY POINT RD 144 STONY POINT ROAD
SANTA ROSA CA
95401-4122
US

IV. Provider business mailing address

144 STONY POINT RD
SANTA ROSA CA
95401-4122
US

V. Phone/Fax

Practice location:
  • Phone: 707-521-4618
  • Fax: 707-544-4626
Mailing address:
  • Phone: 707-521-4618
  • Fax: 707-544-4626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number352467
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: