Provider Demographics
NPI:1134313018
Name:PHILLIPS, MICHELLE ANN (RD/LDN)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ANN
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:RD/LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 PONE LN
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:PA
Mailing Address - Zip Code:16323-3542
Mailing Address - Country:US
Mailing Address - Phone:814-437-1071
Mailing Address - Fax:
Practice Address - Street 1:222 PONE LN
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:PA
Practice Address - Zip Code:16323-3542
Practice Address - Country:US
Practice Address - Phone:814-437-1071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-04
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN003216133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered