Active NPI
Mary Catherine Phelan, LMP
- Specialist
- Vancouver, WA
National Provider Identifier
1164660627
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- MA00024639
- Practice address
- 16500 SE 15TH St
Suite 160
Vancouver, WA 98683-9665 - Phone
- (360) 718-7944
- Fax
- (360) 718-7931
- NPI assigned
- Jan 21, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | MA00024639 | WA | Primary |
Addresses
Primary practice location
16500 SE 15TH St
Suite 160
Vancouver, WA 98683-9665
Mailing address
16500 SE 15TH St
Suite 160
Vancouver, WA 98683-9665
Phone (360) 718-7944
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MA00024639 | WA | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1232496000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1232496000000",
"number": "1164660627",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16500 SE 15TH ST",
"address_2": "SUITE 160",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986839665",
"telephone_number": "360-718-7944",
"fax_number": "360-718-7931"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16500 SE 15TH ST",
"address_2": "SUITE 160",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986839665",
"telephone_number": "360-718-7944",
"fax_number": "360-718-7931"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHELAN",
"first_name": "MARY",
"middle_name": "CATHERINE",
"credential": "LMP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-01-21",
"last_updated": "2009-01-21",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "WA",
"license": "MA00024639",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vancouver, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.