Provider Demographics
NPI:1356655153
Name:PHIPPS, LEIA DOMINIQUE
Entity Type:Individual
Prefix:MS
First Name:LEIA
Middle Name:DOMINIQUE
Last Name:PHIPPS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1587 ADAMS RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45231-3341
Mailing Address - Country:US
Mailing Address - Phone:513-652-3179
Mailing Address - Fax:
Practice Address - Street 1:1587 ADAMS RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45231-3341
Practice Address - Country:US
Practice Address - Phone:513-652-3179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-04
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH361795163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse