Provider Demographics
NPI:1538634175
Name:PHILLIPS, ALEXIS M (NP)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:M
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:
Other - Last Name:SCHAFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1600 W GRAND RIVER AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-2394
Mailing Address - Country:US
Mailing Address - Phone:517-381-6870
Mailing Address - Fax:
Practice Address - Street 1:1600 W GRAND RIVER AVE STE 1
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-2394
Practice Address - Country:US
Practice Address - Phone:517-381-6870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-10
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704306240363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily