Provider Demographics
NPI:1528391232
Name:PHILLIPS, STEPHANIE MARIE (FNP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MARIE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1640 OAK PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-4422
Mailing Address - Country:US
Mailing Address - Phone:415-812-2743
Mailing Address - Fax:
Practice Address - Street 1:1640 OAK PARK BLVD
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-4422
Practice Address - Country:US
Practice Address - Phone:415-812-2743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-13
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18784363LF0000X
HIAPRN-1288363LF0000X
HIRN-68394163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse