Stackhouse, Phyllis C

Stackhouse, Phyllis C is an individual health care provider with primary practice located at 476 Rolling Ridge Dr Suite 101, State College PA 16801-7639. She recently has 2 registered licenses in different health care specialties including Nursing Service Providers / Registered Nurse, Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner. Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner is her primary health care specialty. Stackhouse, Phyllis C can be contacted via phone (814) 689-4980.

Contact Information

Primary practice address
476 Rolling Ridge Dr Suite 101 State College PA 16801-7639
Phone: (814) 689-4980
Fax: (814) 689-4990
Website:
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Health care specialties

SpecialtyCodeLicense #State
Nursing Service Providers / Registered Nurse 163W00000X RN-204012-L Pennsylvania
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X SP-001330-D Pennsylvania

Profile Details

NPI number 1215056718
LBN Legal business name Stackhouse, Phyllis C
Credentials CRNP
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 28th, 2007
Last updated Dec 15th, 2016 - about 10 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1215056718 NPPES
Pennsylvania MEDICAID 103171579

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