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Individual
MR. PHILLIP T DETURK
Active
Individual
MR. PHILLIP T DETURK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71002161A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
28153076A
REGISTERED NURSE LICENSE
IN
01
—
71002161A
NURSE PRACTITIONER AUTHOR
IN
01
—
71002161B
APN CSR REFERENCE
IN
Enumeration date
10/02/2006
Last updated
12/19/2024
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