Provider Demographics
NPI:1831475664
Name:FISHBEIN, PHYLLIS L (RN, APN)
Entity Type:Individual
Prefix:MS
First Name:PHYLLIS
Middle Name:L
Last Name:FISHBEIN
Suffix:
Gender:F
Credentials:RN, APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 E ORMOND AVENUE
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-2053
Mailing Address - Country:US
Mailing Address - Phone:856-428-7632
Mailing Address - Fax:
Practice Address - Street 1:19 E ORMOND AVENUE
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-2053
Practice Address - Country:US
Practice Address - Phone:856-428-7632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-25
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00349500363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily