Provider Demographics
NPI:1396287348
Name:PHILLIPS, ANDREW (STUDENT)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 WALNUT ST.
Mailing Address - Street 2:
Mailing Address - City:SCIO
Mailing Address - State:OH
Mailing Address - Zip Code:43988
Mailing Address - Country:US
Mailing Address - Phone:740-491-0423
Mailing Address - Fax:
Practice Address - Street 1:189 CITATION DR SW
Practice Address - Street 2:
Practice Address - City:PATASKALA
Practice Address - State:OH
Practice Address - Zip Code:43062-8508
Practice Address - Country:US
Practice Address - Phone:740-491-0423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-08
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program