Provider Demographics
NPI:1811561574
Name:PHILLIPS, SOPHIE MARIE (FNP-C)
Entity Type:Individual
Prefix:
First Name:SOPHIE
Middle Name:MARIE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1217 KEARNEY ST STE 2
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-3571
Mailing Address - Country:US
Mailing Address - Phone:586-255-3042
Mailing Address - Fax:
Practice Address - Street 1:1217 KEARNEY ST STE 2
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-3571
Practice Address - Country:US
Practice Address - Phone:810-990-8302
Practice Address - Fax:810-990-8402
Is Sole Proprietor?:No
Enumeration Date:2021-05-18
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704309620363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily