Individual
CAROL PHELAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
10 CENTURY HILL DR, LATHAM, NY 12110-2162
(518) 783-5563
(518) 785-5708
Mailing address
10 CENTURY HILL DR, LATHAM, NY 12110-2162
(518) 783-5563
(518) 785-5708
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
F332976
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02351908
—
NY
01
—
696215
MVP
NY
Enumeration date
09/15/2006
Last updated
07/08/2007
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