Provider Demographics
NPI:1477523777
Name:STYSPECK, PHYLLIS ANDREA (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:PHYLLIS
Middle Name:ANDREA
Last Name:STYSPECK
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MS
Other - First Name:PHYLLIS
Other - Middle Name:
Other - Last Name:EMERSON-STYSPECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:102 OLD AMHERST RD
Mailing Address - Street 2:
Mailing Address - City:SUNDERLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01375-9558
Mailing Address - Country:US
Mailing Address - Phone:413-665-8982
Mailing Address - Fax:
Practice Address - Street 1:271 CAREW ST
Practice Address - Street 2:EP LAB
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01102-9012
Practice Address - Country:US
Practice Address - Phone:413-748-9621
Practice Address - Fax:413-748-9634
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA169848363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health