Healthcare Provider Details

I. General information

NPI: 1255300604
Provider Name (Legal Business Name): KATHRYN ELIZABETH PHILLIPS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36725 53RD PL
BURLINGTON WI
53105-7419
US

IV. Provider business mailing address

36725 53RD PL
BURLINGTON WI
53105-7419
US

V. Phone/Fax

Practice location:
  • Phone: 414-303-9624
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: