Provider Demographics
NPI:1891180220
Name:CHRISTIAN, FELICIA
Entity type:Individual
Prefix:MISS
First Name:FELICIA
Middle Name:
Last Name:CHRISTIAN
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 1:41021 OLD MICHIGAN AVE TRLR 255
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-2731
Mailing Address - Country:US
Mailing Address - Phone:313-459-8961
Mailing Address - Fax:
Practice Address - Street 1:41021 OLD MICHIGAN AVE TRLR 255
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48188-2731
Practice Address - Country:US
Practice Address - Phone:313-459-8961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-02
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI247200000XOther247200000X/TECHNICIAN -OTHER