Provider Demographics
NPI:1679114805
Name:NELSON, PHYLLIS ADOLPHUS (PMHNP-C)
Entity type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:ADOLPHUS
Last Name:NELSON
Suffix:
Gender:F
Credentials:PMHNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1941 ORLEANS ST
Mailing Address - Street 2:APT 632
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48207-2754
Mailing Address - Country:US
Mailing Address - Phone:248-907-4970
Mailing Address - Fax:
Practice Address - Street 1:3281 COOLIDGE HWY
Practice Address - Street 2:
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072-1633
Practice Address - Country:US
Practice Address - Phone:313-915-9138
Practice Address - Fax:313-216-2776
Is Sole Proprietor?:No
Enumeration Date:2019-09-29
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704184714363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily