Provider Demographics
NPI:1114117074
Name:PHILLIPS, AJJIAREE NEKEYIA (NP)
Entity Type:Individual
Prefix:
First Name:AJJIAREE
Middle Name:NEKEYIA
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 LAKESIDE AVE E STE 100
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44114-1172
Mailing Address - Country:US
Mailing Address - Phone:330-307-1116
Mailing Address - Fax:
Practice Address - Street 1:1147 SOUTHERN BLVD NW
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44485-2247
Practice Address - Country:US
Practice Address - Phone:330-307-1116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-26
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.316074163W00000X
OHCNP.023786363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse