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General NPI Number Information
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NPI Number | 1447122585
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Entity Type | Individual
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Provider Name | FELICIA ANDERSEN
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Gender | Female
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Dates
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Enumeration Date | 09/18/2025
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Last Update Date | 09/18/2025
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Provider Practice Location Address
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Address Line | 421 S MULFORD RD STE 203
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City | ROCKFORD
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State | IL
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Zip | 61108-3010
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Country | US
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Telephone | 779-210-2309
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Fax |
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Provider Business Mailing Address
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Address Line | 8658 ABERDEEN RD
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City | CALEDONIA
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State | IL
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Zip | 61011-9642
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Country | US
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Telephone | 815-988-2876
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State | IL
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