Provider Demographics
NPI:1952873556
Name:PHILLIPS, RACHEL LEEANN (LPN)
Entity Type:Individual
Prefix:MS
First Name:RACHEL
Middle Name:LEEANN
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8616 184TH ST NW
Mailing Address - Street 2:
Mailing Address - City:STANWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98292-9107
Mailing Address - Country:US
Mailing Address - Phone:425-953-0673
Mailing Address - Fax:
Practice Address - Street 1:22026 20TH AVE SE
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98021-4449
Practice Address - Country:US
Practice Address - Phone:425-672-7293
Practice Address - Fax:425-329-4640
Is Sole Proprietor?:No
Enumeration Date:2018-12-20
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP60182389164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALP60182389OtherSTATE OF WASHINGTON DEPARTMENT OF HEALTH, LICENSED PRACTICAL NURSE