Provider Demographics
NPI:1770820425
Name:PHILLIPS, SIMONE N (NURSE)
Entity Type:Individual
Prefix:MS
First Name:SIMONE
Middle Name:N
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1640 STERLING PL
Mailing Address - Street 2:APT 1E
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11233-4916
Mailing Address - Country:US
Mailing Address - Phone:347-793-6002
Mailing Address - Fax:
Practice Address - Street 1:801 AMSTERDAM AVE
Practice Address - Street 2:NEW YORK
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-5752
Practice Address - Country:US
Practice Address - Phone:347-793-6002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY310310164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse