Provider Demographics
NPI:1841971835
Name:PHILLIPS, HEATHER MICHELE (RN, CLC)
Entity type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:MICHELE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:RN, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5201 W OLIVE AVE UNIT 151
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85302-4224
Mailing Address - Country:US
Mailing Address - Phone:520-975-8214
Mailing Address - Fax:
Practice Address - Street 1:5201 W OLIVE AVE UNIT 151
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85302-4224
Practice Address - Country:US
Practice Address - Phone:520-975-8214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN417059163W00000X, 163WH0200X, 163WM0102X, 163WP1700X, 163WX0003X, 163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163W00000XNursing Service ProvidersRegistered Nurse
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn
No163WP1700XNursing Service ProvidersRegistered NursePerinatal
No163WX0003XNursing Service ProvidersRegistered NurseObstetric, Inpatient