Individual
TISHA Y PHELPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP-AC
Contact information
Practice address
2315 STOCKTON BLVD, SACRAMENTO, CA 95817
(916) 703-2372
Mailing address
2315 STOCKTON BLVD, SACRAMENTO, CA 95817-2201
(916) 734-2994
(916) 734-0960
Taxonomy
Speciality
Code
Description
License number
State
363LP0222X
Critical Care Pediatric Nurse Practitioner
Primary
23142
CA
363LP0222X
Critical Care Pediatric Nurse Practitioner
6225962-4405
UT
Other
Enumeration date
11/06/2009
Last updated
08/23/2018
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