Provider Demographics
NPI:1598031338
Name:PHILLIPS, LAURA J (RN)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:J
Last Name:PHILLIPS
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 1:280 REGIS DR
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-1427
Mailing Address - Country:US
Mailing Address - Phone:718-697-3121
Mailing Address - Fax:
Practice Address - Street 1:280 REGIS DR
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-1427
Practice Address - Country:US
Practice Address - Phone:718-697-3121
Practice Address - Fax:718-697-3160
Is Sole Proprietor?:No
Enumeration Date:2012-03-27
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY513095-1163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool