Provider Demographics
NPI:1013475284
Name:JOHNSON-PHILLIPS, RAPHAELIA AGNES
Entity Type:Individual
Prefix:
First Name:RAPHAELIA
Middle Name:AGNES
Last Name:JOHNSON-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 1:5901 KNOLLBROOK DR APT 102
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20783-3300
Mailing Address - Country:US
Mailing Address - Phone:240-423-5013
Mailing Address - Fax:
Practice Address - Street 1:440 TAYLOR ST. NE BUILDING B APT 22
Practice Address - Street 2:
Practice Address - City:WASHINGTON DC
Practice Address - State:DC
Practice Address - Zip Code:20017
Practice Address - Country:US
Practice Address - Phone:202-207-7572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-06
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant