Healthcare Provider Details

I. General information

NPI: 1912608795
Provider Name (Legal Business Name): MICHAELA PHILLIPS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2023
Last Update Date: 03/17/2023
Certification Date: 03/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 BAY VIEW AVE
RIVERSIDE RI
02915-4955
US

IV. Provider business mailing address

125 BAY VIEW AVE
RIVERSIDE RI
02915-4955
US

V. Phone/Fax

Practice location:
  • Phone: 401-529-8884
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN55724
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: