Most Relevant Information
Provider Data
| NPI Number: | 1003583238 |
| Provider Name: | ERIC GERALD PHELPS |
| Entity Type: | Individual |
| Taxonomy Code: | 311ZA0620X |
| Specialty: | Custodial Care Facility |
| License Number: |
Most Important Dates
| Enumeration Date: | 08/25/2021 |
| Last Updated: | 08/25/2021 |
Provider Practice Location
104 N 11TH ST
CORNELL
WI
547328106
Practice Location Phone/Fax
| Phone: | 7152023586 |
| Fax: |
Provider Mailing Location
104 N 11TH ST
CORNELL
WI
547328106
Provider Mailing Phone/Fax
| Phone: | 7152023586 |
| Fax: |