Provider Demographics
NPI:1538208459
Name:TUBBS-GINGERICH, PHYLLIS MARIE (RN,BSN,LE,CLT-LYMPHE)
Entity type:Individual
Prefix:MS
First Name:PHYLLIS
Middle Name:MARIE
Last Name:TUBBS-GINGERICH
Suffix:
Gender:F
Credentials:RN,BSN,LE,CLT-LYMPHE
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Other - First Name:
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Mailing Address - Street 1:16360 MONTEREY ROAD
Mailing Address - Street 2:SUITE 270
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-5406
Mailing Address - Country:US
Mailing Address - Phone:408-782-1028
Mailing Address - Fax:408-782-1061
Practice Address - Street 1:16360 MONTEREY ROAD
Practice Address - Street 2:SUITE 270
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-5406
Practice Address - Country:US
Practice Address - Phone:408-782-1028
Practice Address - Fax:408-782-1061
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2019-04-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA489916163W00000X, 163WA2000X, 163WX0200X
CAA236621174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0200XNursing Service ProvidersRegistered NurseOncology
No163W00000XNursing Service ProvidersRegistered Nurse
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4731810001Medicare NSC