Provider Demographics
NPI:1225592256
Name:VAN HORN, PHYLLIS ELAINE
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:ELAINE
Last Name:VAN HORN
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 1:515 OAKLANE ST
Mailing Address - Street 2:
Mailing Address - City:MCPHERSON
Mailing Address - State:KS
Mailing Address - Zip Code:67460-2628
Mailing Address - Country:US
Mailing Address - Phone:620-241-1158
Mailing Address - Fax:
Practice Address - Street 1:515 OAKLANE ST
Practice Address - Street 2:
Practice Address - City:MCPHERSON
Practice Address - State:KS
Practice Address - Zip Code:67460-2628
Practice Address - Country:US
Practice Address - Phone:620-241-1158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-23
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13-45638-091163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice