Provider Demographics
NPI:1568235257
Name:PHIPPS, DEANA (RN)
Entity Type:Individual
Prefix:
First Name:DEANA
Middle Name:
Last Name:PHIPPS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 CRYSTAL FARMS CT
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-3842
Mailing Address - Country:US
Mailing Address - Phone:860-384-0509
Mailing Address - Fax:
Practice Address - Street 1:19 CRYSTAL FARMS CT
Practice Address - Street 2:
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489-3842
Practice Address - Country:US
Practice Address - Phone:860-384-0509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-03
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT171400000X
CT19969671163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No171400000XOther Service ProvidersHealth & Wellness Coach