Phyllis Grice, REGISTERED NURSE
Individual provider Active NPI Registered Nurse · Alsip, IL
NPI 1386078053 · NPPES record last updated Aug 29, 2013
Key facts
- NPI
- 1386078053
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- 041284964 (IL)
- Practice address
- 4359 W Park Lane Dr
Alsip, IL 60803-2638 - Phone
- (708) 385-3604
- NPI assigned
- Aug 29, 2013
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 041284964 | IL | MD | Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 041284964 | IL | Yes |
Addresses
Primary practice location
4359 W Park Lane Dr
Alsip, IL 60803-2638
Mailing address
4359 W Park Lane Dr
Alsip, IL 60803-2638
Phone (708) 385-3604
Other providers in Alsip, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 29, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.