MEDICARE: PHYLLIS FREMPONG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	867899	TX

General Provider Information

NPI Number	:	1962352534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHYLLIS FREMPONG

Provider Business Mailing Address
First Line	:	363 HIGHKNOB RD
Second Line	:
City	:	BOLINGBROOK
State	:	IL
Zip	:	60440-3270
Country	:	US
Telephone Number	:	630-362-0621
Fax Number	:

Provider Business Practice Location Address
First Line	:	2657 BIRNEY PL SE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20020-5946
Country	:	US
Telephone Number	:	770-733-2011
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2026
Last Update Date	:	02/02/2026

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Directions to “ PHYLLIS FREMPONG ” Practice Location

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