Provider Demographics
NPI:1952418022
Name:PHILLIPS, ARLANA R (MD)
Entity Type:Individual
Prefix:
First Name:ARLANA
Middle Name:R
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 30019
Mailing Address - Street 2:2915 GRANT STREET
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68103
Mailing Address - Country:US
Mailing Address - Phone:402-457-1200
Mailing Address - Fax:402-453-1970
Practice Address - Street 1:2915 GRANT STREET
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68103
Practice Address - Country:US
Practice Address - Phone:402-457-1200
Practice Address - Fax:402-453-1970
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE277022080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47066671500Medicaid
NE47066671500Medicaid
H64645Medicare UPIN