Healthcare Provider Details

I. General information

NPI: 1417933649
Provider Name (Legal Business Name): JOHN FELIZZI CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 01/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2006 LIMESTONE RD STE 5
WILMINGTON DE
19808-5553
US

IV. Provider business mailing address

P.O. BOX 1115 ULTRACARE ANESTHESIA
TURNERSVILLE NJ
08012
US

V. Phone/Fax

Practice location:
  • Phone: 302-995-1860
  • Fax: 302-995-5421
Mailing address:
  • Phone: 844-448-5872
  • Fax: 302-995-5421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN519659L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberL6-0A00379
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: