Provider Demographics
NPI:1336324771
Name:PHILLIPS, WENDY LEE (RD, CNSD, CLE)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:LEE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:RD, CNSD, CLE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 FLOWER ST RM 2302
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93305-4144
Mailing Address - Country:US
Mailing Address - Phone:661-326-5421
Mailing Address - Fax:661-862-7694
Practice Address - Street 1:1830 FLOWER ST RM 2302
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93305-4144
Practice Address - Country:US
Practice Address - Phone:661-326-5421
Practice Address - Fax:661-862-7694
Is Sole Proprietor?:No
Enumeration Date:2008-01-03
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA886211133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered