Provider Demographics
NPI:1821724840
Name:PHILLIPS, LA SHAWN
Entity Type:Individual
Prefix:MS
First Name:LA SHAWN
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1664 BRIARHEATH DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60505-5533
Mailing Address - Country:US
Mailing Address - Phone:630-747-7930
Mailing Address - Fax:
Practice Address - Street 1:1664 BRIARHEATH DR
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60505-5533
Practice Address - Country:US
Practice Address - Phone:630-747-7930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-01
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000000OtherNONE