Provider Demographics
NPI:1134219512
Name:SAALWACHTER, PHYLLIS J (ARNP)
Entity type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:J
Last Name:SAALWACHTER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 BOOTH FIELD RD
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-9272
Mailing Address - Country:US
Mailing Address - Phone:270-685-3355
Mailing Address - Fax:
Practice Address - Street 1:2816 VEACH RD STE 308
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-6297
Practice Address - Country:US
Practice Address - Phone:270-926-2929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4999P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily