Provider Demographics
NPI:1811239262
Name:PHILLIPS, CEAIRA (LPN)
Entity Type:Individual
Prefix:
First Name:CEAIRA
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1536 SAINT CLAIR AVE NE STE 130
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44114-2004
Mailing Address - Country:US
Mailing Address - Phone:440-696-3173
Mailing Address - Fax:
Practice Address - Street 1:2781 E 117TH ST
Practice Address - Street 2:APT 1
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44120-2109
Practice Address - Country:US
Practice Address - Phone:440-342-6931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-25
Last Update Date:2022-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH419269163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse