Provider Demographics
NPI:1427388073
Name:VISCONTE, PHYLLIS B (LPN)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:B
Last Name:VISCONTE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9258 ALTA MONTE CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89178-5506
Mailing Address - Country:US
Mailing Address - Phone:702-405-9160
Mailing Address - Fax:
Practice Address - Street 1:9258 ALTA MONTE CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89178-5506
Practice Address - Country:US
Practice Address - Phone:702-405-9160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-04
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVLPN14436164W00000X
NY249859-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse