Provider Demographics
NPI:1275778532
Name:PHILLIS, NANCY E (LPN)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:E
Last Name:PHILLIS
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 1:487 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:GRATIOT
Mailing Address - State:OH
Mailing Address - Zip Code:43740
Mailing Address - Country:US
Mailing Address - Phone:740-408-2481
Mailing Address - Fax:
Practice Address - Street 1:487 MAIN STREET
Practice Address - Street 2:
Practice Address - City:GRATIOT
Practice Address - State:OH
Practice Address - Zip Code:43740
Practice Address - Country:US
Practice Address - Phone:740-408-2481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-15
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN050076164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse