Provider Demographics
NPI:1467145045
Name:PHILLIPS, TANYA
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:PHILLIPS
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 1:2108 BAKER ST
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:49444-1104
Mailing Address - Country:US
Mailing Address - Phone:231-268-6228
Mailing Address - Fax:
Practice Address - Street 1:2108 BAKER ST
Practice Address - Street 2:
Practice Address - City:MUSKEGON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:49444-1104
Practice Address - Country:US
Practice Address - Phone:123-126-8622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula