Provider Demographics
NPI:1639414782
Name:PHILLIP, JUSTINA
Entity Type:Individual
Prefix:
First Name:JUSTINA
Middle Name:
Last Name:PHILLIP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1131 E INTERNATIONAL AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99518-1408
Mailing Address - Country:US
Mailing Address - Phone:907-222-4205
Mailing Address - Fax:
Practice Address - Street 1:100 CLINIC LANE
Practice Address - Street 2:
Practice Address - City:ST. GEORGE
Practice Address - State:AK
Practice Address - Zip Code:99591
Practice Address - Country:US
Practice Address - Phone:907-859-2254
Practice Address - Fax:907-859-2252
Is Sole Proprietor?:No
Enumeration Date:2012-11-30
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker