Provider Demographics
NPI:1336111327
Name:PHILLIPS, ALICE (FNP)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ALICE
Other - Middle Name:MARY
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3581 PALMER DR
Mailing Address - Street 2:SUITE 602
Mailing Address - City:CAMERON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:95682-8239
Mailing Address - Country:US
Mailing Address - Phone:530-626-2920
Mailing Address - Fax:530-672-7047
Practice Address - Street 1:3581 PALMER DR
Practice Address - Street 2:SUITE 602
Practice Address - City:CAMERON PARK
Practice Address - State:CA
Practice Address - Zip Code:95682-8239
Practice Address - Country:US
Practice Address - Phone:530-626-2920
Practice Address - Fax:530-672-7047
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA277298363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner