Provider Demographics
NPI:1184003618
Name:PHELPS, VESCHELLEY DENISE
Entity Type:Individual
Prefix:
First Name:VESCHELLEY
Middle Name:DENISE
Last Name:PHELPS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2734 E TOWER DR APT 528
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45238-6422
Mailing Address - Country:US
Mailing Address - Phone:513-568-1808
Mailing Address - Fax:
Practice Address - Street 1:2734 E TOWER DR APT 528
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45238-6422
Practice Address - Country:US
Practice Address - Phone:513-568-1808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-29
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401661340614374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3121437Medicaid