Provider Demographics
NPI:1114112844
Name:MCALLISTER, PHYLLIS ELAINE
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:ELAINE
Last Name:MCALLISTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 SW AVENUE J
Mailing Address - Street 2:
Mailing Address - City:BELLE GLADE
Mailing Address - State:FL
Mailing Address - Zip Code:33430-4233
Mailing Address - Country:US
Mailing Address - Phone:561-992-9716
Mailing Address - Fax:561-993-8750
Practice Address - Street 1:801 SW AVENUE J
Practice Address - Street 2:
Practice Address - City:BELLE GLADE
Practice Address - State:FL
Practice Address - Zip Code:33430-4233
Practice Address - Country:US
Practice Address - Phone:561-992-9716
Practice Address - Fax:561-993-8750
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL692724696Medicare PIN
692724698Medicare PIN