Provider Demographics
NPI:1497483713
Name:PHILLIPS, TAMMY (MSCN)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MSCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 SNYDER RD
Mailing Address - Street 2:
Mailing Address - City:OLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19547-8911
Mailing Address - Country:US
Mailing Address - Phone:610-587-2180
Mailing Address - Fax:
Practice Address - Street 1:191 SNYDER RD
Practice Address - Street 2:
Practice Address - City:OLEY
Practice Address - State:PA
Practice Address - Zip Code:19547-8911
Practice Address - Country:US
Practice Address - Phone:610-587-2180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-14
Last Update Date:2022-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist