Healthcare Provider Details

I. General information

NPI: 1346378445
Provider Name (Legal Business Name): BETTY J PHILLIPS R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 S FOREST AVE
TEMPE AZ
85283-2816
US

IV. Provider business mailing address

6203 S TAYLOR DR
TEMPE AZ
85283-3221
US

V. Phone/Fax

Practice location:
  • Phone: 480-897-2544
  • Fax: 480-838-1179
Mailing address:
  • Phone: 480-231-4441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License NumberRN099030
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: