Provider Demographics
NPI:1629833900
Name:PHASES CLINIC, PLLC
Entity Type:Organization
Organization Name:PHASES CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:L
Authorized Official - Last Name:WEILAND
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:513-675-3702
Mailing Address - Street 1:15820 9TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98155-6245
Mailing Address - Country:US
Mailing Address - Phone:513-675-3702
Mailing Address - Fax:
Practice Address - Street 1:103 MAIN AVE S STE 208
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:WA
Practice Address - Zip Code:98045-8197
Practice Address - Country:US
Practice Address - Phone:425-835-2726
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-16
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty