Provider Demographics
NPI:1750511945
Name:SMITH, PHYLLIS ANN (CFTS)
Entity Type:Individual
Prefix:MRS
First Name:PHYLLIS
Middle Name:ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:CFTS
Other - Prefix:MRS
Other - First Name:PHYLLIS
Other - Middle Name:ANN
Other - Last Name:WIGGINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CFTS
Mailing Address - Street 1:917 W. 13TH STREET
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-3522
Mailing Address - Country:US
Mailing Address - Phone:252-975-1358
Mailing Address - Fax:252-975-1659
Practice Address - Street 1:917 W. 13TH STREET
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-3522
Practice Address - Country:US
Practice Address - Phone:252-975-1358
Practice Address - Fax:252-975-1659
Is Sole Proprietor?:No
Enumeration Date:2009-07-22
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other