Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | N361190153 | WA |
NPI | 1033769260 |
---|---|
Provider Name | Dr. Elizabeth Rose Phillips |
First Address | Santa Maria, CA 93455-1370 |
Second Address | Vandenberg Afb, CA 93437-6307 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2019 |
Last Update Date | 11/08/2021 |