Provider Demographics
NPI:1457425399
Name:BLOCK, PHYLLIS LYNN (CNM)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:LYNN
Last Name:BLOCK
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2151 LINGLESTOWN RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17110-9499
Mailing Address - Country:US
Mailing Address - Phone:717-541-5661
Mailing Address - Fax:717-541-5634
Practice Address - Street 1:2151 LINGLESTOWN RD
Practice Address - Street 2:SUITE 210
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-9499
Practice Address - Country:US
Practice Address - Phone:717-541-5661
Practice Address - Fax:717-541-5634
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMW008493L176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102717269001Medicaid