Provider Demographics
NPI:1508698036
Name:PHEMISTER, DANA JILL (RN MSN)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:JILL
Last Name:PHEMISTER
Suffix:
Gender:F
Credentials:RN MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4725 121ST ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-8339
Mailing Address - Country:US
Mailing Address - Phone:806-786-7149
Mailing Address - Fax:
Practice Address - Street 1:4725 121ST ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-8339
Practice Address - Country:US
Practice Address - Phone:806-786-7149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX607445163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse