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General NPI Number Information
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NPI Number | 1477690899
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Entity Type | Individual
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Provider Name | PAULA BRUTZ PHELPS PA
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Gender | Female
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Dates
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Enumeration Date | 02/01/2007
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Last Update Date | 06/19/2018
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Provider Practice Location Address
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Address Line | 1151 HOSPITAL WAY SUITE D, SUITE 201
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City | POCATELLO
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State | ID
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Zip | 83201-5091
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Country | US
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Telephone | 208-478-2472
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4908
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City | POCATELLO
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State | ID
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Zip | 83205-4908
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Country | US
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Telephone | 208-236-1600
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Fax | 208-209-1027
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA-166
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License Number State | ID
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