Provider Demographics
NPI:1356615637
Name:PHILLIPS, ELIZABETH ANNE (FNP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANNE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:121 MEDICAL CENTER DR STE 2550
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-2681
Mailing Address - Country:US
Mailing Address - Phone:207-373-6155
Mailing Address - Fax:207-373-6475
Practice Address - Street 1:121 MEDICAL CENTER DR STE 2550
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-2681
Practice Address - Country:US
Practice Address - Phone:207-373-6155
Practice Address - Fax:207-373-6475
Is Sole Proprietor?:No
Enumeration Date:2012-03-03
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60266342363LF0000X
MECNP221479363LF0000X
OR201250027NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily