Provider Demographics
NPI:1639110968
Name:PHILLIPS, BARBARA C (NP)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:C
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1015 4TH AVE W
Mailing Address - Street 2:SUITE AB
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-5467
Mailing Address - Country:US
Mailing Address - Phone:360-915-7794
Mailing Address - Fax:360-915-7936
Practice Address - Street 1:1015 4TH AVE W
Practice Address - Street 2:SUITE AB
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-5467
Practice Address - Country:US
Practice Address - Phone:360-915-7794
Practice Address - Fax:360-915-7936
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30002105363LF0000X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAS23690Medicare UPIN