Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 6748-015 | WI |
NPI | 1043452758 |
---|---|
Provider Name | Dr. Barbara Lynn Phillips |
First Address | Woodruff, WI 54568-0890 |
Second Address | Woodruff, WI 54568-9636 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2009 |
Last Update Date | 25/09/2013 |