Healthcare Provider Details

I. General information

NPI: 1962807800
Provider Name (Legal Business Name): YVONNE PHILLIPS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2014
Last Update Date: 11/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DC VETERANS AFFAIRS MEDICAL CTR 50 IRVINGTON ST. NW
WASHINGTON DC
20422-0001
US

IV. Provider business mailing address

1706 BERRY LN
DISTRICT HEIGHTS MD
20747-1824
US

V. Phone/Fax

Practice location:
  • Phone: 202-745-8000
  • Fax:
Mailing address:
  • Phone: 517-410-1384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR213619
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704289399
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: