Provider Demographics
NPI:1649061730
Name:PHILLIPS, MELISSA LYNNE ANN
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:LYNNE ANN
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 1:8025 13TH ST APT 506
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-5824
Mailing Address - Country:US
Mailing Address - Phone:202-710-6502
Mailing Address - Fax:
Practice Address - Street 1:3298 FORT LINCOLN DR NE APT 632
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-4323
Practice Address - Country:US
Practice Address - Phone:202-391-3857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-16
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC3747P1801X3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant