Provider Demographics
NPI:1467067264
Name:PHELPS, CHANDRA RUTH (RN)
Entity Type:Individual
Prefix:
First Name:CHANDRA
Middle Name:RUTH
Last Name:PHELPS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 13TH ST STE 110
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:NE
Mailing Address - Zip Code:68818-2426
Mailing Address - Country:US
Mailing Address - Phone:402-631-7267
Mailing Address - Fax:
Practice Address - Street 1:616 13TH ST STE 110
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:NE
Practice Address - Zip Code:68818-2426
Practice Address - Country:US
Practice Address - Phone:402-631-7267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-09
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE80718163WA0400X, 163WC1500X, 163WN1003X, 163WP0808X, 163WW0101X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WN1003XNursing Service ProvidersRegistered NurseNutrition Support
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory