Mark Aaron Phelan, RN

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

N-29179 Issued in ID

Practice address

779 S. Tennyson Way
Boise, ID 83709

Phone

(208) 724-1829

Fax

(208) 724-1829

NPI assigned

Sep 5, 2017

Last updated

Jul 21, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1504569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1457879975",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "779 S TENNYSON WAY",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837097738",
            "telephone_number": "208-724-1829",
            "fax_number": "208-724-1829"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "779 S. TENNYSON WAY",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "83709",
            "telephone_number": "208-724-1829",
            "fax_number": "208-724-1829"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHELAN",
        "first_name": "MARK",
        "middle_name": "AARON",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-09-05",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "ID",
            "license": "N-29179",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "M8070381",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "M8071148",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ryan Pham, MD
• Tuan Duc Pham, DDS
• Brennen Phan, RN
• Pharmacy Solutions, Inc.
• Pharmerica Drug Systems Inc (Pharmerica)
• Sarah Harley Phelan, DNP
• Philip D Jensen MD Chartered
• Alexis Phillips, D.M.D.
• Andrew Phillips
• Bradley Phillips, MD

• Registered Nurse in Boise, ID
• Providers in Boise, ID by specialty
• Registered Nurse in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.