Provider Demographics
NPI:1700243870
Name:PHELPS, ERIN (LVN)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:PHELPS
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 1:4960 VIRGINIA RD
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95901-9739
Mailing Address - Country:US
Mailing Address - Phone:916-804-5180
Mailing Address - Fax:
Practice Address - Street 1:18 COUNTY CENTER DR
Practice Address - Street 2:
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95965-3335
Practice Address - Country:US
Practice Address - Phone:530-538-7705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-20
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA292499164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse