Provider Demographics
NPI:1053987800
Name:CANN, FELICITY MAUVAE (RDN, LDN)
Entity type:Individual
Prefix:
First Name:FELICITY
Middle Name:MAUVAE
Last Name:CANN
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1931 N HOWE ST APT GW
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-5177
Mailing Address - Country:US
Mailing Address - Phone:253-709-0608
Mailing Address - Fax:
Practice Address - Street 1:1931 N HOWE ST APT GW
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-5177
Practice Address - Country:US
Practice Address - Phone:253-709-0608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered