Provider Demographics
NPI:1548713308
Name:FANDREYER, FELICITAS
Entity type:Individual
Prefix:
First Name:FELICITAS
Middle Name:
Last Name:FANDREYER
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 1:545 SOUTH RD
Mailing Address - Street 2:
Mailing Address - City:TEMPLETON
Mailing Address - State:MA
Mailing Address - Zip Code:01468-1119
Mailing Address - Country:US
Mailing Address - Phone:978-852-8294
Mailing Address - Fax:
Practice Address - Street 1:1 HARVARD RD
Practice Address - Street 2:
Practice Address - City:SHIRLEY
Practice Address - State:MA
Practice Address - Zip Code:01464-2434
Practice Address - Country:US
Practice Address - Phone:978-514-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-28
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2286273364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health