Provider Demographics
NPI:1164411153
Name:CHRISTOPHER, PHYLLIS (FNP)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:
Last Name:CHRISTOPHER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 BITTERN CT
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-3516
Mailing Address - Country:US
Mailing Address - Phone:315-796-8866
Mailing Address - Fax:585-463-3105
Practice Address - Street 1:300 MERIDIAN CENTRE BLVD
Practice Address - Street 2:SUITE 320
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-3981
Practice Address - Country:US
Practice Address - Phone:315-796-8866
Practice Address - Fax:585-463-3105
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF331026363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDD1377Medicare UPIN
NYCC0108Medicare ID - Type UnspecifiedMEDICARE