Provider Demographics
NPI:1801198411
Name:PHILLIPS, NADIA TRACEY (RN)
Entity Type:Individual
Prefix:MISS
First Name:NADIA
Middle Name:TRACEY
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3958 PAULDING AVE
Mailing Address - Street 2:APT. 2R
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-4700
Mailing Address - Country:US
Mailing Address - Phone:917-600-4600
Mailing Address - Fax:
Practice Address - Street 1:3958 PAULDING AVE
Practice Address - Street 2:APT. 2R
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-4700
Practice Address - Country:US
Practice Address - Phone:917-600-4600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-02
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY632441-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse