Provider Demographics
NPI:1992109425
Name:FELICIA, SUSAN C (FNP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:C
Last Name:FELICIA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:CANNON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 HYGEIA DR
Mailing Address - Street 2:SUITE 2300
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2049
Mailing Address - Country:US
Mailing Address - Phone:302-733-1507
Mailing Address - Fax:302-733-4998
Practice Address - Street 1:4755 OGLETOWN STANTON RD
Practice Address - Street 2:SUITE 2E99 - HEART FAILURE PROGRAM
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19718-2200
Practice Address - Country:US
Practice Address - Phone:302-733-5165
Practice Address - Fax:302-733-5649
Is Sole Proprietor?:No
Enumeration Date:2014-10-13
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL1-0033550163W00000X
DELG-0000791363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse