Provider Demographics
NPI:1013458066
Name:PHELPS, CHANEL S (LPN)
Entity Type:Individual
Prefix:
First Name:CHANEL
Middle Name:S
Last Name:PHELPS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:CHANEL
Other - Middle Name:S
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:15 MILLINER ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14611-1111
Mailing Address - Country:US
Mailing Address - Phone:585-754-8038
Mailing Address - Fax:
Practice Address - Street 1:15 MILLINER ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14611-1111
Practice Address - Country:US
Practice Address - Phone:585-754-8038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-10
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY328319164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse