Provider Demographics
NPI:1194520064
Name:PHELPS, CARON
Entity type:Individual
Prefix:MRS
First Name:CARON
Middle Name:
Last Name:PHELPS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 PENNSYLVANIA AVE APT 17H
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11239-1917
Mailing Address - Country:US
Mailing Address - Phone:718-909-6855
Mailing Address - Fax:
Practice Address - Street 1:1310 PENNSYLVANIA AVE APT 17H
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11239-1917
Practice Address - Country:US
Practice Address - Phone:718-909-6855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-15
Last Update Date:2025-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula