Basic Information
| Provider Information | |||||||||
| NPI: | 1265523773 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCPHERRON | ||||||||
| FirstName: | PHYLLIS | ||||||||
| MiddleName: | H. | ||||||||
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| Credential: | A.P.R.N., F.N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1025 S 7TH ST | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 627032416 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2175287541 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1770 E LAKE SHORE DR | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | DECATUR | ||||||||
| State: | IL | ||||||||
| PostalCode: | 625213832 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2174283424 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.