Provider Demographics
NPI:1417655101
Name:PHANOR, HOMILER ELIE
Entity Type:Individual
Prefix:DR
First Name:HOMILER
Middle Name:ELIE
Last Name:PHANOR
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 1:4 FAIRFIELD DR
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-7311
Mailing Address - Country:US
Mailing Address - Phone:908-349-0574
Mailing Address - Fax:
Practice Address - Street 1:600 N LAUREL ST
Practice Address - Street 2:
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18201-4339
Practice Address - Country:US
Practice Address - Phone:570-455-7890
Practice Address - Fax:570-455-7560
Is Sole Proprietor?:No
Enumeration Date:2023-02-21
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No171WH0202XOther Service ProvidersContractorHome Modifications
No372600000XNursing Service Related ProvidersAdult Companion
No374J00000XNursing Service Related ProvidersDoula