MEDICARE: MS. HEATHER MICHELE PHILLIPS RN, CLC

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	163W00000X	Registered Nurse	RN417059	AZ
2	163WH0200X	Home Health Registered Nurse	RN417059	AZ
3	163WM0102X	Maternal Newborn Registered Nurse	RN417059	AZ
4	163WP1700X	Perinatal Registered Nurse	RN417059	AZ
5	163WX0003X	Inpatient Obstetric Registered Nurse	RN417059	AZ
6	163WL0100X	Lactation Consultant (Registered Nurse)	RN417059	AZ

General Provider Information

NPI Number	:	1841971835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. HEATHER MICHELE PHILLIPS RN, CLC

Provider Business Mailing Address
First Line	:	5201 W OLIVE AVE UNIT 151
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85302-4224
Country	:	US
Telephone Number	:	520-975-8214
Fax Number	:

Provider Business Practice Location Address
First Line	:	5201 W OLIVE AVE UNIT 151
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85302-4224
Country	:	US
Telephone Number	:	520-975-8214
Fax Number	:

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

Provider Enumeration Date	:	07/31/2023
Last Update Date	:	07/31/2023

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