Provider Demographics
NPI:1780856229
Name:PHILLIPS, ELAINE (ANP)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1717
Mailing Address - Street 2:
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368-0160
Mailing Address - Country:US
Mailing Address - Phone:360-385-0800
Mailing Address - Fax:360-379-3710
Practice Address - Street 1:1441 F ST
Practice Address - Street 2:
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368-5143
Practice Address - Country:US
Practice Address - Phone:360-385-0800
Practice Address - Fax:360-379-3710
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-25
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30005335363LW0102X
AK483363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health