Healthcare Provider Details

I. General information

NPI: 1376072538
Provider Name (Legal Business Name): ALEXISS LEE PHILLIPS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2017
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 S MAIN ST STE C
WOLFEBORO NH
03894-4664
US

IV. Provider business mailing address

240 S MAIN ST
WOLFEBORO NH
03894-4455
US

V. Phone/Fax

Practice location:
  • Phone: 603-569-7620
  • Fax: 603-569-7619
Mailing address:
  • Phone: 603-569-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number116764-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: