Provider Demographics
NPI:1871265330
Name:PHILLIPS, JANALENE (PA-STUDENT)
Entity Type:Individual
Prefix:
First Name:JANALENE
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:PA-STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 N WALNUT ST FL 3
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-4738
Mailing Address - Country:US
Mailing Address - Phone:240-527-2752
Mailing Address - Fax:240-527-2781
Practice Address - Street 1:24 N WALNUT ST FL 3
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-4738
Practice Address - Country:US
Practice Address - Phone:240-527-2752
Practice Address - Fax:240-527-2781
Is Sole Proprietor?:No
Enumeration Date:2021-10-04
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant