Provider Demographics
NPI:1154643500
Name:ANDERSON, PHYLLIS GLENN (ANP-BC)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:GLENN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:271 GROVE AVE
Mailing Address - Street 2:BUILDING E
Mailing Address - City:VERONA
Mailing Address - State:NJ
Mailing Address - Zip Code:07044-1730
Mailing Address - Country:US
Mailing Address - Phone:973-571-9550
Mailing Address - Fax:973-571-9747
Practice Address - Street 1:610 PEMBERTON BROWNS MILLS RD
Practice Address - Street 2:
Practice Address - City:PEMBERTON
Practice Address - State:NJ
Practice Address - Zip Code:08068-1537
Practice Address - Country:US
Practice Address - Phone:609-726-4031
Practice Address - Fax:609-894-8964
Is Sole Proprietor?:No
Enumeration Date:2010-02-25
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN06346100363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health