Provider Demographics
NPI:1932431418
Name:METCALF, FELICIA (RN LMT)
Entity type:Individual
Prefix:
First Name:FELICIA
Middle Name:
Last Name:METCALF
Suffix:
Gender:F
Credentials:RN LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 347
Mailing Address - Street 2:2 GRAY AVENUE
Mailing Address - City:WESTHAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11977-0347
Mailing Address - Country:US
Mailing Address - Phone:631-288-3655
Mailing Address - Fax:
Practice Address - Street 1:2 GRAY AVENUE
Practice Address - Street 2:
Practice Address - City:WESTHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11977-0347
Practice Address - Country:US
Practice Address - Phone:631-288-3655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-08
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY620524-1163WM0705X, 163WM1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No163WM1400XNursing Service ProvidersRegistered NurseNurse Massage Therapist (NMT)