Provider Demographics
NPI:1942591714
Name:PHELEY, MAUREEN (RN)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:PHELEY
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 1:3617 S PACIFIC HWY
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-8957
Mailing Address - Country:US
Mailing Address - Phone:541-512-3182
Mailing Address - Fax:541-512-1026
Practice Address - Street 1:1001 MANZANITA ST
Practice Address - Street 2:
Practice Address - City:CENTRAL POINT
Practice Address - State:OR
Practice Address - Zip Code:97502-3064
Practice Address - Country:US
Practice Address - Phone:541-512-3182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-27
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200843144RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse