Provider Demographics
NPI:1184184475
Name:PHELPS, GAYLE ILENE (CNM RN)
Entity Type:Individual
Prefix:
First Name:GAYLE
Middle Name:ILENE
Last Name:PHELPS
Suffix:
Gender:F
Credentials:CNM RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 WHITE POND DR STE B
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44320-1178
Mailing Address - Country:US
Mailing Address - Phone:234-205-2040
Mailing Address - Fax:
Practice Address - Street 1:809 WHITE POND DR STE B
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44320-1178
Practice Address - Country:US
Practice Address - Phone:234-205-2040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-22
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPN.CNM.03772363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner