MEDICARE: FELISTER FELICIAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1083006126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FELISTER FELICIAN

Provider Business Mailing Address
First Line	:	4430 68TH PL
Second Line	:	APT C2
City	:	LANDOVER HILLS
State	:	MD
Zip	:	20784-2015
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4430 68TH PL
Second Line	:	APT C2
City	:	LANDOVER HILLS
State	:	MD
Zip	:	20784-2015
Country	:	US
Telephone Number	:	507-271-7976
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/26/2015
Last Update Date	:	02/26/2015

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