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General NPI Number Information
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NPI Number | 1104906056
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Entity Type | Individual
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Provider Name | PHYLLIS D GEARRING-ANDERSON ARNP
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Gender | Female
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Dates
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Enumeration Date | 10/16/2006
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Last Update Date | 07/26/2022
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Provider Practice Location Address
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Address Line | 606 OAKESDALE AVE SW STE C200
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City | RENTON
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State | WA
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Zip | 98057-5227
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Country | US
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Telephone | 866-259-1629
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Fax | 855-666-8541
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Provider Business Mailing Address
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Address Line | 500 KIRTS BLVD STE 100
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City | TROY
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State | MI
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Zip | 48084-4135
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Country | US
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Telephone | 248-434-6169
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Fax | 855-618-6655
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | AP30005430
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | AP30005430
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License Number State | WA
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