| Doctor Name: | PHYLLIS GLENN ANDERSON |
| NPI Number: | 1154643500 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | ANP-BC |
| License Number: | 26NN06346100 |
| Business Practice Address: | 610 Pemberton Browns Mills Rd Pemberton, NJ - 080681537 |
| Business Phone Number: | 6097264031 |
| Business Fax Number: | 6098948964 |
| Mailing Address: | 271 Grove Ave, Building E VERONA |
| State: | NJ |
| Postal Code: | 070441730 |
| Phone Number: | 9735719550 |
| Fax Number: | 9735719747 |
| NPI Enumeration Date: | 02/25/2010 |
| NPI Last Update Date: | 12/12/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2200X |
| License Number: | 26NN06346100 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Adult Health |
| Taxonomy Definition: | |