Healthcare Provider Details

I. General information

NPI: 1003481599
Provider Name (Legal Business Name): MELANIE PHILLIPS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2021
Last Update Date: 05/26/2021
Certification Date: 05/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2045 N FRANKLIN ST
DENVER CO
80205-5437
US

IV. Provider business mailing address

1553 S BEECH ST
LAKEWOOD CO
80228-3732
US

V. Phone/Fax

Practice location:
  • Phone: 303-338-4545
  • Fax:
Mailing address:
  • Phone: 720-261-9821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number1646175
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: