Provider Demographics
NPI:1174867741
Name:PHELPS, DOROTHY WINKLER (RN)
Entity Type:Individual
Prefix:MRS
First Name:DOROTHY
Middle Name:WINKLER
Last Name:PHELPS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15675 AMBAUM BLVD SW
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-2523
Mailing Address - Country:US
Mailing Address - Phone:206-433-2413
Mailing Address - Fax:206-433-2110
Practice Address - Street 1:2725 SW116TH STREET
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98146
Practice Address - Country:US
Practice Address - Phone:206-631-4904
Practice Address - Fax:206-631-4999
Is Sole Proprietor?:No
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00072743163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool