Healthcare Provider Details

I. General information

NPI: 1225293731
Provider Name (Legal Business Name): DEBORAH ROSE PHILLIPS CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2008
Last Update Date: 07/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 EDENWOOD LN
NORTH LITTLE ROCK AR
72116-5106
US

IV. Provider business mailing address

6 EDENWOOD LN
NORTH LITTLE ROCK AR
72116-5106
US

V. Phone/Fax

Practice location:
  • Phone: 501-833-3322
  • Fax: 501-833-3322
Mailing address:
  • Phone: 501-833-3322
  • Fax: 501-833-3322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberR88712
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: