Provider Demographics
NPI:1164589099
Name:BOYSEN-PHILLIPS, IRENE E (LPN)
Entity Type:Individual
Prefix:MRS
First Name:IRENE
Middle Name:E
Last Name:BOYSEN-PHILLIPS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4720 YELM HWY SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-4986
Mailing Address - Country:US
Mailing Address - Phone:360-491-4359
Mailing Address - Fax:360-491-6417
Practice Address - Street 1:4720 YELM HWY SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-4986
Practice Address - Country:US
Practice Address - Phone:360-491-4359
Practice Address - Fax:360-491-6417
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00010461225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist