Provider Demographics
NPI:1184858367
Name:PHANORD, PARNELL GEIGER
Entity Type:Individual
Prefix:
First Name:PARNELL
Middle Name:GEIGER
Last Name:PHANORD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 FAIRFIELD CIR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-4712
Mailing Address - Country:US
Mailing Address - Phone:631-357-3408
Mailing Address - Fax:
Practice Address - Street 1:2 FAIRFIELD CIR
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-4712
Practice Address - Country:US
Practice Address - Phone:631-357-3408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-04
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY294593164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse