Provider Demographics
NPI:1063957736
Name:PHINNEY, JP
Entity type:Individual
Prefix:
First Name:JP
Middle Name:
Last Name:PHINNEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5102 OAK PARK RD
Mailing Address - Street 2:STE B
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-3027
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5102 OAK PARK RD
Practice Address - Street 2:STE B
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-3027
Practice Address - Country:US
Practice Address - Phone:919-395-0869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-04
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor