Healthcare Provider Details

I. General information

NPI: 1124224209
Provider Name (Legal Business Name): DEBORAH A PHILLIPS PHD, ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 12/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 CLUB RD STE 160
EUGENE OR
97401-2439
US

IV. Provider business mailing address

3355 N DELTA HWY #104
EUGENE OR
97408-7194
US

V. Phone/Fax

Practice location:
  • Phone: 541-345-1722
  • Fax: 541-485-7049
Mailing address:
  • Phone: 206-349-8362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number201070014
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number201504380NP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: