Provider Demographics
NPI:1669628301
Name:PHILLPOTTS, MECHEL MARJORIE (RN)
Entity Type:Individual
Prefix:
First Name:MECHEL
Middle Name:MARJORIE
Last Name:PHILLPOTTS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MECHEL
Other - Middle Name:MARJORIE
Other - Last Name:PHILLPOTTS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:4042 PAULDING AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-4722
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4042 PAULDING AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-4722
Practice Address - Country:US
Practice Address - Phone:917-569-1470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-13
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY552149-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse