Healthcare Provider Details

I. General information

NPI: 1831787381
Provider Name (Legal Business Name): FELICIA PATE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2021
Last Update Date: 01/08/2021
Certification Date: 01/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 58TH ST NE
WASHINGTON DC
20019-6847
US

IV. Provider business mailing address

228 58TH ST NE
WASHINGTON DC
20019-6847
US

V. Phone/Fax

Practice location:
  • Phone: 202-793-9400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License NumberD210868
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: