Provider Demographics
NPI:1235348046
Name:CASON, PHYLLIS PATRICIA (RN, MS, FNP-C)
Entity Type:Individual
Prefix:MS
First Name:PHYLLIS
Middle Name:PATRICIA
Last Name:CASON
Suffix:
Gender:F
Credentials:RN, MS, FNP-C
Other - Prefix:MS
Other - First Name:PATTY
Other - Middle Name:
Other - Last Name:CASON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:400 W 30TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90007-3320
Mailing Address - Country:US
Mailing Address - Phone:213-284-3200
Mailing Address - Fax:213-284-3350
Practice Address - Street 1:400 W 30TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90007-3320
Practice Address - Country:US
Practice Address - Phone:213-284-3200
Practice Address - Fax:213-284-3350
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN 460227 NP5483363LF0000X
CARN 460227 NP 5483363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANPF5483OtherFURNISHING LICENSE