Healthcare Provider Details

I. General information

NPI: 1871890863
Provider Name (Legal Business Name): FIDELIS HEALTHCARE SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2011
Last Update Date: 02/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 HARRIS CORNERS PKWY SUITE 100
CHARLOTTE NC
28269-3790
US

IV. Provider business mailing address

20 N MARTINGALE RD SUITE 180
SCHAUMBURG IL
60173-2412
US

V. Phone/Fax

Practice location:
  • Phone: 704-307-4400
  • Fax:
Mailing address:
  • Phone: 847-605-0501
  • Fax: 847-517-1085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. DAWN M GILBERT
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 847-605-0501