Healthcare Provider Details

I. General information

NPI: 1205541380
Provider Name (Legal Business Name): DENISE LORA PHILIPS MSN, RN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2023
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 OLD MARLTON PIKE W SUITE 1
MARLTON NJ
08053-2076
US

IV. Provider business mailing address

3003 QUEENSGATE DR APT 350
RICHLAND WA
99352-4237
US

V. Phone/Fax

Practice location:
  • Phone: 856-988-9101
  • Fax:
Mailing address:
  • Phone: 484-321-1237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ01455200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61491645
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP026986
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: