Provider Demographics
NPI:1023101631
Name:HANSELL, PHYLLIS LEPPKE (FNP-C)
Entity type:Individual
Prefix:MISS
First Name:PHYLLIS
Middle Name:LEPPKE
Last Name:HANSELL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 NW 11TH ST #E37
Mailing Address - Street 2:
Mailing Address - City:HERMISTON
Mailing Address - State:OR
Mailing Address - Zip Code:97838-8604
Mailing Address - Country:US
Mailing Address - Phone:541-567-5305
Mailing Address - Fax:541-667-3487
Practice Address - Street 1:600 NW 11TH ST STE E37
Practice Address - Street 2:
Practice Address - City:HERMISTON
Practice Address - State:OR
Practice Address - Zip Code:97838-8604
Practice Address - Country:US
Practice Address - Phone:541-567-5305
Practice Address - Fax:541-667-3487
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200050032NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR237486Medicaid
OR237486Medicaid
ORR168707Medicare PIN