Provider Demographics
NPI:1336354604
Name:PHILLIPS, TONI YVETTE (LPN)
Entity Type:Individual
Prefix:MISS
First Name:TONI
Middle Name:YVETTE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7465 MELYNNE TRCE
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-7720
Mailing Address - Country:US
Mailing Address - Phone:614-747-8336
Mailing Address - Fax:
Practice Address - Street 1:7465 MELYNNE TRCE
Practice Address - Street 2:
Practice Address - City:CANAL WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:43110-7720
Practice Address - Country:US
Practice Address - Phone:614-747-8336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH103219164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse