Provider Demographics
NPI:1073232344
Name:PHILLIPS, ISABELLA ANN (PA)
Entity Type:Individual
Prefix:
First Name:ISABELLA
Middle Name:ANN
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 FOREST GLEN DR
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-8465
Mailing Address - Country:US
Mailing Address - Phone:712-308-4459
Mailing Address - Fax:
Practice Address - Street 1:412 FOREST GLEN DR
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-8465
Practice Address - Country:US
Practice Address - Phone:712-308-4459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant