Healthcare Provider Details

I. General information

NPI: 1134160583
Provider Name (Legal Business Name): BARBARA C. PHILLIPS, ARNP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 09/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 4TH AVE W SUITE AB
OLYMPIA WA
98502-5467
US

IV. Provider business mailing address

1015 4TH AVE W SUITE AB
OLYMPIA WA
98502-5467
US

V. Phone/Fax

Practice location:
  • Phone: 360-915-7794
  • Fax: 360-915-7936
Mailing address:
  • Phone: 360-915-7794
  • Fax: 360-915-7936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP3002105
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAP3002105
License Number StateWA

VIII. Authorized Official

Name: BARBARA C. PHILLIPS
Title or Position: NURSE PRACTITIONER
Credential: NP
Phone: 360-915-7794