Provider Demographics
NPI:1144604794
Name:PHELAN, ELIZABETH (RN FNP-BC MSN)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:PHELAN
Suffix:
Gender:F
Credentials:RN FNP-BC MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 CORPORATE PLAZA DR STE 150
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7921
Mailing Address - Country:US
Mailing Address - Phone:949-244-6227
Mailing Address - Fax:
Practice Address - Street 1:2077 HARBOR BLVD
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-2630
Practice Address - Country:US
Practice Address - Phone:949-722-2510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-14
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN 464512363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily