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General NPI Number Information
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NPI Number | 1861981110
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Entity Type | Individual
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Provider Name | MATTHEW ROBERT PHELAN CRNP
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Gender | Male
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Dates
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Enumeration Date | 05/02/2018
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Last Update Date | 01/21/2021
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Provider Practice Location Address
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Address Line | 205 SOUTH FRONT STREET 4TH FLOOR, BMA
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City | HARRISBURG
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State | PA
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Zip | 17104-1619
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Country | US
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Telephone | 717-231-8555
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Fax | 717-231-8568
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Provider Business Mailing Address
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Address Line | 205 SOUTH FRONT STREET 4TH FLOOR, BMA
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City | HARRISBURG
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State | PA
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Zip | 17104-1619
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Country | US
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Telephone | 717-231-8555
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Fax | 717-231-8568
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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 | SP018608
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License Number State | PA
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