Provider Demographics
NPI:1477303048
Name:PHILLIPS, COURTNIE ARIANE
Entity Type:Individual
Prefix:
First Name:COURTNIE
Middle Name:ARIANE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:COURTNIE
Other - Middle Name:
Other - Last Name:MELE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20 FERNGLADE CT
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10918-2637
Mailing Address - Country:US
Mailing Address - Phone:845-637-7475
Mailing Address - Fax:
Practice Address - Street 1:87 E MAIN ST # 1
Practice Address - Street 2:
Practice Address - City:WASHINGTONVILLE
Practice Address - State:NY
Practice Address - Zip Code:10992-1279
Practice Address - Country:US
Practice Address - Phone:845-495-0517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist