Healthcare Provider Details

I. General information

NPI: 1831890904
Provider Name (Legal Business Name): MARTHA PHIPPS LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2023
Last Update Date: 04/27/2023
Certification Date: 04/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

792 FOXFIRE TRL
VANDALIA OH
45377-2548
US

IV. Provider business mailing address

5031 RENARD DR
HUBER HEIGHTS OH
45424-4317
US

V. Phone/Fax

Practice location:
  • Phone: 937-776-3834
  • Fax:
Mailing address:
  • Phone: 937-546-5503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number105148
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: