Provider Demographics
NPI:1174954556
Name:STRADER, FELICIA
Entity type:Individual
Prefix:
First Name:FELICIA
Middle Name:
Last Name:STRADER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1829 COPPERFIELD LN
Mailing Address - Street 2:
Mailing Address - City:CENTER POINT
Mailing Address - State:AL
Mailing Address - Zip Code:35215-4559
Mailing Address - Country:US
Mailing Address - Phone:205-856-0412
Mailing Address - Fax:
Practice Address - Street 1:1829 COPPERFIELD LN
Practice Address - Street 2:
Practice Address - City:CENTER POINT
Practice Address - State:AL
Practice Address - Zip Code:35215-4559
Practice Address - Country:US
Practice Address - Phone:205-856-0412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-10
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2-049772164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL164W00000XOtherLPN