Healthcare Provider Details

I. General information

NPI: 1942321609
Provider Name (Legal Business Name): JENNIFER LORRAINE PHILLIPS N.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 W CHESTNUT AVE
MERCHANTVILLE NJ
08109-2305
US

IV. Provider business mailing address

41 W CHESTNUT AVE
MERCHANTVILLE NJ
08109-2305
US

V. Phone/Fax

Practice location:
  • Phone: 856-488-7067
  • Fax:
Mailing address:
  • Phone: 856-488-7067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number0990000126
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: