Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 209014913 | IL |
NPI | 1013458843 |
---|---|
Provider Name | Melissa Phillips |
First Address | Oak Lawn, IL 60453-3767 |
Second Address | Oak Lawn, IL 60453-3767 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2017 |
Last Update Date | 13/03/2017 |