Provider Demographics
NPI:1407348303
Name:PHELPS, BARBARA DANNIELLE (NP-C)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:DANNIELLE
Last Name:PHELPS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MS
Other - First Name:BARBARA
Other - Middle Name:DANNIELLE
Other - Last Name:FOURNIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:26 QUEEN STREET
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01610-2473
Mailing Address - Country:US
Mailing Address - Phone:508-860-7800
Mailing Address - Fax:508-860-7855
Practice Address - Street 1:26 QUEEN STREET
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01610-2473
Practice Address - Country:US
Practice Address - Phone:508-860-7800
Practice Address - Fax:508-860-7855
Is Sole Proprietor?:No
Enumeration Date:2018-06-06
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2297858363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily