Healthcare Provider Details

I. General information

NPI: 1801724299
Provider Name (Legal Business Name): FELECIA VANTRIA BROOKS WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 AMBER VALLEY PKWY S APT 1
FARGO ND
58104-8772
US

IV. Provider business mailing address

5301 AMBER VALLEY PKWY S APT 1
FARGO ND
58104-8772
US

V. Phone/Fax

Practice location:
  • Phone: 813-970-4294
  • Fax:
Mailing address:
  • Phone: 813-970-4294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License NumberNDL-30-3034
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: