Provider Demographics
NPI:1255144010
Name:MCCASKILL, PHYLLENCIA GEREA
Entity type:Individual
Prefix:MS
First Name:PHYLLENCIA
Middle Name:GEREA
Last Name:MCCASKILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20415 ERIN ST STE 148
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-4535
Mailing Address - Country:US
Mailing Address - Phone:313-288-0139
Mailing Address - Fax:
Practice Address - Street 1:16828 SANTA ROSA DR
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48221-2629
Practice Address - Country:US
Practice Address - Phone:313-288-0139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider