Healthcare Provider Details

I. General information

NPI: 1942831565
Provider Name (Legal Business Name): DOREEN PHILLIPS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2020
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9036 35TH AVE SW STE B
SEATTLE WA
98126-3821
US

IV. Provider business mailing address

14090 SOUTHWEST FWY STE 300
SUGAR LAND TX
77478-3679
US

V. Phone/Fax

Practice location:
  • Phone: 832-390-4630
  • Fax:
Mailing address:
  • Phone: 833-744-5935
  • Fax: 833-777-6653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number859555
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number859555
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1034616
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN95280740
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number258356
License Number StateAZ
# 6
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209023667
License Number StateIL
# 7
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNP95020768
License Number StateCA
# 8
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP61160521
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: