Provider Demographics
NPI:1578694980
Name:PHILLIPS, LAURA K (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:K
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:K
Other - Last Name:TOTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:143 LONGWATER DRIVE
Mailing Address - Street 2:SOUTH SHORE MEDICAL CENTER
Mailing Address - City:NORWELL
Mailing Address - State:MA
Mailing Address - Zip Code:02061-1795
Mailing Address - Country:US
Mailing Address - Phone:781-878-5200
Mailing Address - Fax:781-878-6750
Practice Address - Street 1:143 LONGWATER DR
Practice Address - Street 2:SOUTH SHORE MEDICAL CENTER
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061-1683
Practice Address - Country:US
Practice Address - Phone:781-878-5200
Practice Address - Fax:781-878-6750
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA262089363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
042297845OtherPHCS/MULTI-PLAN
MA000065002OtherMEDICARE
MA110085470AMedicaid
MASS0070OtherBCBSMA
042297845OtherTRICARD
1578694980OtherFALLON HEALTH CARE