Healthcare Provider Details

I. General information

NPI: 1144759960
Provider Name (Legal Business Name): CAMERON PHILLIPS FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2017
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 S MAIN ST
WOLFEBORO NH
03894-4455
US

IV. Provider business mailing address

240 S MAIN ST
WOLFEBORO NH
03894-4664
US

V. Phone/Fax

Practice location:
  • Phone: 603-569-7500
  • Fax:
Mailing address:
  • Phone: 603-569-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number5009541
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number262358
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5009541
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number116817-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: