Provider Demographics
NPI:1073667796
Name:MCGEHEAN, PHYLLIS A (CRNA)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:A
Last Name:MCGEHEAN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 EXECUTIVE CAMPUS FL 2
Mailing Address - Street 2:ROUTE 70 CUTHBERT BLVD
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002-4103
Mailing Address - Country:US
Mailing Address - Phone:856-356-5935
Mailing Address - Fax:856-356-4879
Practice Address - Street 1:1 COOPER PLZ
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1461
Practice Address - Country:US
Practice Address - Phone:856-342-2919
Practice Address - Fax:856-968-8239
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNR36968367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ002756 CK2Medicare PIN