Provider Demographics
NPI:1225127087
Name:PHILLIPS, JOSEPH W JR (CRNP)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:W
Last Name:PHILLIPS
Suffix:JR
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:JOSEPH
Other - Middle Name:W
Other - Last Name:PHILLIPS
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:CRNP
Mailing Address - Street 1:625 CHERRY TREE LN
Mailing Address - Street 2:SUITE 102
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401-8419
Mailing Address - Country:US
Mailing Address - Phone:724-438-4300
Mailing Address - Fax:724-438-4700
Practice Address - Street 1:625 CHERRY TREE LN
Practice Address - Street 2:SUITE 102
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-8419
Practice Address - Country:US
Practice Address - Phone:724-438-4300
Practice Address - Fax:724-438-4700
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP007680363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
096432Medicare ID - Type Unspecified