Provider Demographics
NPI:1891446092
Name:PHILLIPS-REID, FONTELLA (HOMEHEALTH, CNA)
Entity Type:Individual
Prefix:
First Name:FONTELLA
Middle Name:
Last Name:PHILLIPS-REID
Suffix:
Gender:F
Credentials:HOMEHEALTH, CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4770 WOODVIEW DR
Mailing Address - Street 2:
Mailing Address - City:DEL CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73115-4224
Mailing Address - Country:US
Mailing Address - Phone:405-777-0778
Mailing Address - Fax:
Practice Address - Street 1:4770 WOODVIEW DR
Practice Address - Street 2:
Practice Address - City:DEL CITY
Practice Address - State:OK
Practice Address - Zip Code:73115-4224
Practice Address - Country:US
Practice Address - Phone:405-777-0778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-10
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK37V618580815163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health