Provider Demographics
NPI:1356080907
Name:PHILLIPS, EMILY PAIGE (LPN)
Entity Type:Individual
Prefix:MS
First Name:EMILY
Middle Name:PAIGE
Last Name:PHILLIPS
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 1:4 LOCK ST APT B
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:NY
Mailing Address - Zip Code:13135-2374
Mailing Address - Country:US
Mailing Address - Phone:315-857-4628
Mailing Address - Fax:
Practice Address - Street 1:4 LOCK ST APT B
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:NY
Practice Address - Zip Code:13135-2374
Practice Address - Country:US
Practice Address - Phone:315-857-4628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-01
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY326679164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse