Healthcare Provider Details

I. General information

NPI: 1043515711
Provider Name (Legal Business Name): CHERRY T PHILLIPS LLHIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2011
Last Update Date: 01/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 HUDSON LN SUITE 1-C
MONROE LA
71201-6045
US

IV. Provider business mailing address

1101 HUDSON LN SUITE 1-C
MONROE LA
71201-6045
US

V. Phone/Fax

Practice location:
  • Phone: 318-325-2363
  • Fax: 318-325-2361
Mailing address:
  • Phone: 318-325-2363
  • Fax: 318-325-2361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number680
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: