Healthcare Provider Details

I. General information

NPI: 1023629698
Provider Name (Legal Business Name): FELICIA CANN-HANSON PROSTHETIC SPECIALIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2020
Last Update Date: 03/29/2021
Certification Date: 03/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7407 MANCHESTER RD
SAINT LOUIS MO
63143-3031
US

IV. Provider business mailing address

7407 MANCHESTER RD
SAINT LOUIS MO
63143-3031
US

V. Phone/Fax

Practice location:
  • Phone: 314-449-1115
  • Fax:
Mailing address:
  • Phone: 314-449-1115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: