Provider Demographics
NPI:1699376202
Name:ROTH-PHILLIPS, VERONICA LYNN (FNP)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:LYNN
Last Name:ROTH-PHILLIPS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:IL
Mailing Address - Zip Code:62339-1026
Mailing Address - Country:US
Mailing Address - Phone:217-779-3139
Mailing Address - Fax:
Practice Address - Street 1:1107 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-2600
Practice Address - Country:US
Practice Address - Phone:217-214-3447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.022338363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily