Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | AG0813036 | PA |
NPI | 1003244047 |
---|---|
Provider Name | Carroll L Phillips |
First Address | Mc Murray, PA 15317-3357 |
Second Address | Pittsburgh, PA 15213-1245 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/10/2013 |
Last Update Date | 07/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
AG0813036 | AANP (01) | PA |