Healthcare Provider Details

I. General information

NPI: 1639226558
Provider Name (Legal Business Name): NORMA JACKSON FELICIANO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. NORMA JACKSON

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 E 24TH ST
PATERSON NJ
07513-1424
US

IV. Provider business mailing address

227 CLINTON ST
PATERSON NJ
07522-1259
US

V. Phone/Fax

Practice location:
  • Phone: 973-519-1355
  • Fax:
Mailing address:
  • Phone: 973-790-9455
  • Fax: 973-790-9432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0500X
TaxonomyHemodialysis Registered Nurse
License NumberNO70158
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: