Pine, Phyllis
Pine, Phyllis is an sole proprietor health care provider with primary practice located at 1000 E Aztec Ave , Gallup NM 87301-5509. She recently has only one registered license in Behavioral Health & Social Service Providers / School, which is considered as her primary health care specialty. Pine, Phyllis can be contacted via phone (505) 721-1800.Contact Information
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / School | 103TS0200X | 257139 | New Mexico |
Profile Details
| NPI number | 1417174848 |
|---|---|
| LBN Legal business name | Pine, Phyllis |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Apr 19th, 2007 |
| Last updated | Jul 8th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1417174848 | NPPES |
| New Mexico | MEDICAID | 47809876 |
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