Provider Demographics
NPI:1639409121
Name:PHILLIPS, CARRIE MAY (LVN)
Entity Type:Individual
Prefix:MS
First Name:CARRIE
Middle Name:MAY
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1477 HARVARD AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612-6011
Mailing Address - Country:US
Mailing Address - Phone:559-322-0397
Mailing Address - Fax:
Practice Address - Street 1:1477 HARVARD AVE
Practice Address - Street 2:SUITE B
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-6011
Practice Address - Country:US
Practice Address - Phone:559-322-0397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-05
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN117280164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse