Healthcare Provider Details

I. General information

NPI: 1417127549
Provider Name (Legal Business Name): FELICIA LUCY, LORENA DICKERSON CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: FELICIA LUCY, LORENA WASHINGTON CNM

II. Dates (important events)

Enumeration Date: 03/04/2008
Last Update Date: 04/21/2023
Certification Date: 04/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1234 HUFFMAN MILL RD
BURLINGTON NC
27215-8700
US

IV. Provider business mailing address

1234 HUFFMAN MILL ROAD
BURLINGTON NC
27215-8700
US

V. Phone/Fax

Practice location:
  • Phone: 336-538-1234
  • Fax: 336-584-6811
Mailing address:
  • Phone: 336-538-1234
  • Fax: 336-584-6811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number335632
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: