MEDICARE: MRS. VENESIA FORBES-PHILLIPS RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker	534051	NY

General Provider Information

NPI Number	:	1205092780
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VENESIA FORBES-PHILLIPS RN

Provider Business Mailing Address
First Line	:	4 W PROSPECT AVE
Second Line	:
City	:	MOUNT VERNON
State	:	NY
Zip	:	10550-2027
Country	:	US
Telephone Number	:	914-667-0300
Fax Number	:	914-667-1407

Provider Business Practice Location Address
First Line	:	4 W PROSPECT AVE
Second Line	:
City	:	MOUNT VERNON
State	:	NY
Zip	:	10550-2027
Country	:	US
Telephone Number	:	914-667-0300
Fax Number	:	914-667-1407

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2008
Last Update Date	:	08/04/2008

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