Individual
MRS. PHYLLIS A PENGELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
WHNP
Contact information
Practice address
2330 NE DIVISION ST, SUITE 7, BEND, OR 97701-3530
(503) 775-4931
(503) 788-7285
Mailing address
3727 NE MARTIN LUTHER KING JR BLVD, ATTN: CREDENTIALING, PORTLAND, OR 97212-1112
(503) 775-4931
(503) 788-7285
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
200350128NP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
270097
—
OR
Enumeration date
06/24/2006
Last updated
11/14/2011
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