Provider Demographics
NPI:1568111516
Name:PHILLIPS, ROBIN LEE
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:LEE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:LEE
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:436 RAVEN WAY APT C
Mailing Address - Street 2:
Mailing Address - City:CHUBBUCK
Mailing Address - State:ID
Mailing Address - Zip Code:83202-1940
Mailing Address - Country:US
Mailing Address - Phone:208-540-0245
Mailing Address - Fax:
Practice Address - Street 1:436 RAVEN WAY APT C
Practice Address - Street 2:
Practice Address - City:CHUBBUCK
Practice Address - State:ID
Practice Address - Zip Code:83202-1940
Practice Address - Country:US
Practice Address - Phone:208-540-0245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-18
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty