Healthcare Provider Details

I. General information

NPI: 1730170382
Provider Name (Legal Business Name): SHEILA LYNNE PHILLIPS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 10/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 E MCKINLEY AVE
MISHAWAKA IN
46545-6285
US

IV. Provider business mailing address

PO BOX 670 915 NORTH VANBUREN ST.
SHIPSHEWANA IN
46565
US

V. Phone/Fax

Practice location:
  • Phone: 574-256-2556
  • Fax: 574-258-4278
Mailing address:
  • Phone: 260-768-4185
  • Fax: 260-768-7214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71000651A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: