Provider Demographics
NPI:1164624979
Name:HARPER, PHYLLIS MARY (RN)
Entity Type:Individual
Prefix:MS
First Name:PHYLLIS
Middle Name:MARY
Last Name:HARPER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
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Mailing Address - Street 1:241 MARKET STREET STATE HWY 209
Mailing Address - Street 2:BOX #42
Mailing Address - City:CUMBOLA
Mailing Address - State:PA
Mailing Address - Zip Code:17930-0042
Mailing Address - Country:US
Mailing Address - Phone:570-277-6406
Mailing Address - Fax:
Practice Address - Street 1:241 MARKET STREET STATE HWY 209
Practice Address - Street 2:BOX #42
Practice Address - City:CUMBOLA
Practice Address - State:PA
Practice Address - Zip Code:17930-0042
Practice Address - Country:US
Practice Address - Phone:570-277-6406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN267084L163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice