Healthcare Provider Details

I. General information

NPI: 1518925007
Provider Name (Legal Business Name): PHYLLIS J CHESTER DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 08/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 NORTH MAIN
LOVINGTON NM
88260-2830
US

IV. Provider business mailing address

1600 NORTH MAIN
LOVINGTON NM
88260-2830
US

V. Phone/Fax

Practice location:
  • Phone: 575-396-6611
  • Fax: 575-396-1454
Mailing address:
  • Phone: 575-396-6611
  • Fax: 575-396-1454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024113734
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN-83664
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCNP-02905
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: