Healthcare Provider Details

I. General information

NPI: 1699754739
Provider Name (Legal Business Name): PHYLLIS V. STILSON N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4323 W RIVERSIDE DR
BURBANK CA
91505-4044
US

IV. Provider business mailing address

27361 SIERRA HWY SPACE #3
CANYON COUNTRY CA
91351-3053
US

V. Phone/Fax

Practice location:
  • Phone: 818-763-7691
  • Fax:
Mailing address:
  • Phone: 818-763-7691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberRN218909
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: