Healthcare Provider Details

I. General information

NPI: 1033029475
Provider Name (Legal Business Name): ANGELA Y PHILLIP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 LINDBERG AVE
JOHNSTON RI
02919-2851
US

IV. Provider business mailing address

10 LINDBERG AVE
JOHNSTON RI
02919-2851
US

V. Phone/Fax

Practice location:
  • Phone: 401-642-5634
  • Fax:
Mailing address:
  • Phone: 401-642-5634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number202033
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: