Provider Demographics
NPI:1134160583
Name:BARBARA C. PHILLIPS, ARNP, LLC
Entity type:Organization
Organization Name:BARBARA C. PHILLIPS, ARNP, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:C
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:360-915-7794
Mailing Address - Street 1:1015 4TH AVE W
Mailing Address - Street 2:SUITE AB
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-5467
Mailing Address - Country:US
Mailing Address - Phone:360-915-7794
Mailing Address - Fax:360-915-7936
Practice Address - Street 1:1015 4TH AVE W
Practice Address - Street 2:SUITE AB
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-5467
Practice Address - Country:US
Practice Address - Phone:360-915-7794
Practice Address - Fax:360-915-7936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP3002105363LG0600X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAS23690Medicare UPIN