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General NPI Number Information
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NPI Number | 1881247633
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Entity Type | Individual
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Provider Name | MARY PHELPS MS, CNS
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Gender | Female
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Dates
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Enumeration Date | 07/22/2019
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Last Update Date | 07/22/2019
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Provider Practice Location Address
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Address Line | 1236 PENNSYLVANIA AVE SE
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City | WASHINGTON
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State | DC
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Zip | 20003-2226
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Country | US
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Telephone | 609-477-3050
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Fax |
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Provider Business Mailing Address
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Address Line | 2909 N ST SE
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City | WASHINGTON
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State | DC
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Zip | 20019-2139
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Country | US
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Telephone | 609-477-3050
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Fax |
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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 | 133N00000X
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Taxonomy Name | Nutritionist
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License Number | NU10000021
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License Number State | DC
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