Provider Demographics
NPI:1023294873
Name:ORECK, PHYLLIS S (RN, FNP, MSN)
Entity type:Individual
Prefix:MS
First Name:PHYLLIS
Middle Name:S
Last Name:ORECK
Suffix:
Gender:F
Credentials:RN, FNP, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4938 BRUGES AVE
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-2803
Mailing Address - Country:US
Mailing Address - Phone:818-571-2096
Mailing Address - Fax:
Practice Address - Street 1:4938 BRUGES AVE
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-2803
Practice Address - Country:US
Practice Address - Phone:818-571-2096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-10
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA380777363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily