Provider Demographics
NPI:1174190490
Name:PHILLIPS, VICKIE LYNN (MEDICAL ESTHETICIAN)
Entity Type:Individual
Prefix:MRS
First Name:VICKIE
Middle Name:LYNN
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MEDICAL ESTHETICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3637 MEDINA RD STE 203
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-8155
Mailing Address - Country:US
Mailing Address - Phone:330-592-8978
Mailing Address - Fax:
Practice Address - Street 1:3637 MEDINA RD STE 203
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-8155
Practice Address - Country:US
Practice Address - Phone:330-592-8978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-06
Last Update Date:2021-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZA2600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherArt, Medical