Provider Demographics
NPI:1477794204
Name:PHIPPS, DELORIS J (LPN)
Entity Type:Individual
Prefix:MRS
First Name:DELORIS
Middle Name:J
Last Name:PHIPPS
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 1:58 RIO GRANDE DR.
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14514-9760
Mailing Address - Country:US
Mailing Address - Phone:585-889-5618
Mailing Address - Fax:
Practice Address - Street 1:58 RIO GRANDE DR.
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14514-9760
Practice Address - Country:US
Practice Address - Phone:585-889-5618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-06
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY192594-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse