Provider Demographics
NPI:1104906056
Name:GEARRING-ANDERSON, PHYLLIS D (ARNP)
Entity type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:D
Last Name:GEARRING-ANDERSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:PHYLLIS
Other - Middle Name:D
Other - Last Name:GEARRING-WATSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:500 KIRTS BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-4135
Mailing Address - Country:US
Mailing Address - Phone:248-434-6169
Mailing Address - Fax:855-618-6655
Practice Address - Street 1:606 OAKESDALE AVE SW STE C200
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-5227
Practice Address - Country:US
Practice Address - Phone:866-259-1629
Practice Address - Fax:855-666-8541
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30005430363L00000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9650136Medicaid
WA0235143OtherSTATE L&I
WA8942895OtherCRIME VICTIMS
WA0214165OtherL & I
WA0214165OtherL & I
WA8942895OtherCRIME VICTIMS