Provider Demographics
NPI:1255801056
Name:PHILLIPS, NATIEKA DANIELLE
Entity type:Individual
Prefix:
First Name:NATIEKA
Middle Name:DANIELLE
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 1:1799 STUMPF BLVD.
Mailing Address - Street 2:BUIDING 7 STE 2
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70056
Mailing Address - Country:US
Mailing Address - Phone:504-366-6217
Mailing Address - Fax:
Practice Address - Street 1:1799 STUMPF BLVD.
Practice Address - Street 2:BUIDING 7 STE 2
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056
Practice Address - Country:US
Practice Address - Phone:504-366-6217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-05
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator