Individual
ERIC GERALD PHELPS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
104 N 11TH ST, CORNELL, WI 54732-8106
(715) 202-3586
Mailing address
104 N 11TH ST, CORNELL, WI 54732-8106
(715) 202-3586
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100178091
—
WI
Enumeration date
08/25/2021
Last updated
08/25/2021
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