Provider Demographics
NPI:1467195776
Name:PHILLIPI, ANNETTA RAE (MSN, RN, NC-BC, PN)
Entity Type:Individual
Prefix:
First Name:ANNETTA
Middle Name:RAE
Last Name:PHILLIPI
Suffix:
Gender:F
Credentials:MSN, RN, NC-BC, PN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2818 MAINE ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-4413
Mailing Address - Country:US
Mailing Address - Phone:217-695-4543
Mailing Address - Fax:
Practice Address - Street 1:2818 MAINE ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-4413
Practice Address - Country:US
Practice Address - Phone:217-695-4543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-14
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041275195163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse