Provider Demographics
NPI:1982915732
Name:PHILLIPS, AMBER (PN)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:PN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 THOMAS CT
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45215-1835
Mailing Address - Country:US
Mailing Address - Phone:513-771-4022
Mailing Address - Fax:
Practice Address - Street 1:1202 THOMAS CT
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45215-1835
Practice Address - Country:US
Practice Address - Phone:513-771-4022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-27
Last Update Date:2010-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN136302164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse