Provider Demographics
NPI:1164566915
Name:HUGHES, PHYLLIS E (NP)
Entity Type:Individual
Prefix:MRS
First Name:PHYLLIS
Middle Name:E
Last Name:HUGHES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 PHELPS AVE
Mailing Address - Street 2:
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621-1312
Mailing Address - Country:US
Mailing Address - Phone:973-427-7676
Mailing Address - Fax:973-427-7476
Practice Address - Street 1:1114 GOFFLE RD
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:NJ
Practice Address - Zip Code:07506-2014
Practice Address - Country:US
Practice Address - Phone:973-427-7676
Practice Address - Fax:973-427-7476
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN04244200363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ016-984CNMMedicare ID - Type Unspecified