Healthcare Provider Details

I. General information

NPI: 1770981102
Provider Name (Legal Business Name): VANESSA LYNN PHELPS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2014
Last Update Date: 04/27/2021
Certification Date: 04/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

789 N CLARE AVE
HARRISON MI
48625-9194
US

IV. Provider business mailing address

789 N CLARE AVE
HARRISON MI
48625-9194
US

V. Phone/Fax

Practice location:
  • Phone: 989-539-2141
  • Fax: 989-539-2143
Mailing address:
  • Phone: 989-539-2141
  • Fax: 989-539-2143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704305072
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: