Healthcare Provider Details

I. General information

NPI: 1306028378
Provider Name (Legal Business Name): LAUREN N PHILLIPS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2007
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1065 RIDGE RD
WEBSTER NY
14580-2952
US

IV. Provider business mailing address

100 KINGS HWY S
ROCHESTER NY
14617-5504
US

V. Phone/Fax

Practice location:
  • Phone: 585-872-2273
  • Fax: 585-872-2275
Mailing address:
  • Phone: 585-922-5462
  • Fax: 585-922-1011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number014180
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: