Healthcare Provider Details

I. General information

NPI: 1760190359
Provider Name (Legal Business Name): APRIL GAY FELICITAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2022
Last Update Date: 11/11/2022
Certification Date: 11/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 INTREPID AVE
PHILADELPHIA PA
19112-1229
US

IV. Provider business mailing address

4451 BAY VISTA BLVD
BREMERTON WA
98312-4659
US

V. Phone/Fax

Practice location:
  • Phone: 253-393-0345
  • Fax:
Mailing address:
  • Phone: 253-393-0345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN60896878
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: