Healthcare Provider Details

I. General information

NPI: 1043252216
Provider Name (Legal Business Name): CHANIEL FELICA AGE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 04/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 SAINT ANDREW ST
NEW ORLEANS LA
70130-5022
US

IV. Provider business mailing address

6150 EASTOVER DR
NEW ORLEANS LA
70128-3614
US

V. Phone/Fax

Practice location:
  • Phone: 504-250-6759
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberRN088296
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: