Basic Information
| Provider Information | |||||||||
| NPI: | 1639158603 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FELDER | ||||||||
| FirstName: | DEBRA | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 690 CANTON ST | ||||||||
| Address2: | STE 325 | ||||||||
| City: | WESTWOOD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02090 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7814077713 | ||||||||
| FaxNumber: | 7814070998 | ||||||||
| Practice Location | |||||||||
| Address1: | 51 STATE RD | ||||||||
| Address2: | |||||||||
| City: | N DARTMOUTH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027473319 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5089971274 | ||||||||
| FaxNumber: | 5089102209 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2006 | ||||||||
| LastUpdateDate: | 02/06/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WX1100X | 144876 | MA | N | Nursing Service Providers | Registered Nurse | Ophthalmic | 367500000X | 144876 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.