Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | RN116530 | GA |
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | RN116530NP | GA |
NPI | 1518104348 |
---|---|
Provider Name | Elaine F Phelps |
First Address | Covington, GA 30016-8089 |
Second Address | Atlanta, GA 30308-2208 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2009 |
Last Update Date | 30/10/2015 |