Provider Demographics
NPI:1295087260
Name:CHICHESTER, PHYLLIS (LVN)
Entity type:Individual
Prefix:MS
First Name:PHYLLIS
Middle Name:
Last Name:CHICHESTER
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29506 PORT ROYAL WAY
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-7946
Mailing Address - Country:US
Mailing Address - Phone:949-677-5866
Mailing Address - Fax:
Practice Address - Street 1:29506 PORT ROYAL WAY
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-7946
Practice Address - Country:US
Practice Address - Phone:949-677-5866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-15
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA268963164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse