Provider Demographics
NPI:1245380815
Name:PHILLIPS, BRENDA (CRNP)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 GERRIE DR
Mailing Address - Street 2:
Mailing Address - City:UPPER ST CLAIR
Mailing Address - State:PA
Mailing Address - Zip Code:15241-1807
Mailing Address - Country:US
Mailing Address - Phone:412-758-8181
Mailing Address - Fax:
Practice Address - Street 1:1306 E 38TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16504-3018
Practice Address - Country:US
Practice Address - Phone:814-825-7440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP007557363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily