Provider Demographics
NPI:1952516122
Name:PHILLIPS, DANA LEE (LMP)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:LEE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 LINWOOD AVE SW
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98512-6847
Mailing Address - Country:US
Mailing Address - Phone:360-280-2578
Mailing Address - Fax:
Practice Address - Street 1:5600 PACIFIC AVE NE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-6847
Practice Address - Country:US
Practice Address - Phone:360-493-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 00013210174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist