Healthcare Provider Details

I. General information

NPI: 1073246427
Provider Name (Legal Business Name): FELICIA BRANT LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2022
Last Update Date: 05/12/2023
Certification Date: 05/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14701 NATIONAL HWY SW STE 5&6
LAVALE MD
21502-6573
US

IV. Provider business mailing address

14701 NATIONAL HWY SW STE 5&6
LAVALE MD
21502-6573
US

V. Phone/Fax

Practice location:
  • Phone: 301-687-0940
  • Fax: 301-687-0948
Mailing address:
  • Phone: 301-687-0940
  • Fax: 301-687-0948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLP55568
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: