Provider Demographics
NPI:1346522349
Name:PHILLIPS, FELISA B (LVN)
Entity Type:Individual
Prefix:MRS
First Name:FELISA
Middle Name:B
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:568 WISCONSIN ST
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91768-3639
Mailing Address - Country:US
Mailing Address - Phone:909-236-2610
Mailing Address - Fax:
Practice Address - Street 1:568 WISCONSIN ST
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91768-3639
Practice Address - Country:US
Practice Address - Phone:909-236-2610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN 161251164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse