Provider Demographics
NPI:1932324324
Name:PHILLIPS, RENEE (RN-WHCNP)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:RN-WHCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3902 WALLINGFORD DR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-7683
Mailing Address - Country:US
Mailing Address - Phone:972-841-9863
Mailing Address - Fax:
Practice Address - Street 1:2601 N FLOYD RD
Practice Address - Street 2:SUITE 1.606
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-1407
Practice Address - Country:US
Practice Address - Phone:972-883-2747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX505980363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health