Healthcare Provider Details

I. General information

NPI: 1477214526
Provider Name (Legal Business Name): MONICA LINDSEY PHILLIPS RDMS, RVT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2021
Last Update Date: 09/15/2022
Certification Date: 09/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8541 FM 2021
LUFKIN TX
75904-8968
US

IV. Provider business mailing address

8541 FM 2021
LUFKIN TX
75904-8968
US

V. Phone/Fax

Practice location:
  • Phone: 936-404-2566
  • Fax:
Mailing address:
  • Phone: 936-404-2566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number157549
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: