Pengelly, Phyllis A
Pengelly, Phyllis A is an individual health care provider with primary practice located at 2330 Ne Division St Suite 7, Bend OR 97701-3530. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Women's Health, which is considered as her primary health care specialty. Pengelly, Phyllis A can be contacted via phone (503) 775-4931.Contact Information
Primary practice address
2330 Ne Division St Suite 7
Bend OR 97701-3530
Phone: (503) 775-4931
Fax: (503) 788-7285
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Women's Health | 363LW0102X | 200350128NP | Oregon |
Profile Details
| NPI number | 1265468912 |
|---|---|
| LBN Legal business name | Pengelly, Phyllis A |
| Credentials | Women's Health Nurse Practitioner (WHNP) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 24th, 2006 |
| Last updated | Nov 14th, 2011 - about 15 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1265468912 | NPPES |
| Oregon | MEDICAID | 270097 |
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