Provider Demographics
NPI:1922081801
Name:INMAN, PHYLLIS J (NP)
Entity Type:Individual
Prefix:MRS
First Name:PHYLLIS
Middle Name:J
Last Name:INMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 CLIFTON ST
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-2620
Mailing Address - Country:US
Mailing Address - Phone:781-322-7041
Mailing Address - Fax:617-234-7981
Practice Address - Street 1:YOUVILLE HOSPITAL
Practice Address - Street 2:1575 CAMBRIDGE STREET
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-4398
Practice Address - Country:US
Practice Address - Phone:617-876-4344
Practice Address - Fax:617-234-7981
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA165171363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
S67160Medicare UPIN
MANP1438Medicare ID - Type Unspecified