Healthcare Provider Details

I. General information

NPI: 1134528870
Provider Name (Legal Business Name): MONICA PHILLIPS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2014
Last Update Date: 03/21/2023
Certification Date: 03/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 E APACHE ST
FARMINGTON NM
87401-6925
US

IV. Provider business mailing address

300 N KENTUCKY AVE
ROSWELL NM
88201-4636
US

V. Phone/Fax

Practice location:
  • Phone: 505-326-2012
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN-77364
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: