Provider Demographics
NPI:1003132440
Name:PHILLIPS, ANIKA SCHULTE (RN, CNM)
Entity Type:Individual
Prefix:MRS
First Name:ANIKA
Middle Name:SCHULTE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:RN, CNM
Other - Prefix:MISS
Other - First Name:ANIKA
Other - Middle Name:BERIT
Other - Last Name:SCHULTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:927 CHURCHILL ST W
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-6605
Mailing Address - Country:US
Mailing Address - Phone:651-439-1234
Mailing Address - Fax:651-275-8234
Practice Address - Street 1:927 CHURCHILL ST W
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-6605
Practice Address - Country:US
Practice Address - Phone:651-439-1234
Practice Address - Fax:651-275-8234
Is Sole Proprietor?:No
Enumeration Date:2010-04-09
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 194139-1163W00000X
MDCERTIFICATION# 13258367A00000X
GARN209679367A00000X
MNCNM 0157367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse