Provider Demographics
NPI:1669851481
Name:PHILLIPS, AMANDA KAY (RN, CPN)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:KAY
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:RN, CPN
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:KAY
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4667 RANCHVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-3862
Mailing Address - Country:US
Mailing Address - Phone:951-490-7276
Mailing Address - Fax:
Practice Address - Street 1:4667 RANCHVIEW CIR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92649-3862
Practice Address - Country:US
Practice Address - Phone:951-490-7276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-26
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA706654163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics