MEDICARE: MS. IETHA L PHILLIPS LPN

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	2080H0002X	Pediatric Hospice and Palliative Medicine Physician	PN100508	OH

General Provider Information

NPI Number	:	1619178670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. IETHA L PHILLIPS LPN

Provider Business Mailing Address
First Line	:	1346 SHAWVIEW AVE.
Second Line	:
City	:	E. CLEVELAND
State	:	OH
Zip	:	44112
Country	:	US
Telephone Number	:	216-761-1296
Fax Number	:

Provider Business Practice Location Address
First Line	:	1346 SHAWVIEW AVE.
Second Line	:
City	:	E. CLEVELAND
State	:	OH
Zip	:	44112-2720
Country	:	US
Telephone Number	:	216-761-1296
Fax Number	:

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

Provider Enumeration Date	:	05/29/2007
Last Update Date	:	04/09/2008

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