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NPI Code Detail

MEDICARE: KELLY SUSAN PHILLIPS CPNP

MEDICARE: KELLY SUSAN PHILLIPS CPNP
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
1363LP0200XPediatric Nurse PractitionerMP14450167DE

General Provider Information

NPI Number : 1669572848
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY SUSAN PHILLIPS CPNP
Provider Business Mailing Address
First Line : 113 BRIGHTON RD
Second Line :
City : REHOBOTH BEACH
State : DE
Zip : 19971-3526
Country : US
Telephone Number : 302-226-2877
Fax Number :
Provider Business Practice Location Address
First Line : 424 MULBERRY ST
Second Line : SUITE 1
City : MILTON
State : DE
Zip : 19968-1628
Country : US
Telephone Number : 302-684-0561
Fax Number : 302-684-3563
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/25/2006
Last Update Date : 02/10/2009

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