Provider Demographics
NPI:1457794711
Name:PHILLIPS, LAURA SUZANNE (RN BSN)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:SUZANNE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 AUBURN AVE
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-5626
Mailing Address - Country:US
Mailing Address - Phone:315-269-2092
Mailing Address - Fax:
Practice Address - Street 1:43 AUBURN AVE
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-5626
Practice Address - Country:US
Practice Address - Phone:315-269-2092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-16
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY509886-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse