=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023691896
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHARI PHILLIPS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/29/2021
-----------------------------------------------------
Last Update Date | 07/17/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 116 ASH AVE NW SUITE 2
-----------------------------------------------------
City | WADENA
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56482-1347
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 218-640-7368
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 310 3RD ST NW
-----------------------------------------------------
City | WADENA
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56482-1118
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 218-640-7368
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/COUNSELOR
-----------------------------------------------------
Name | SHARI LYNN PHILLIPS
-----------------------------------------------------
Credential | LPCC
-----------------------------------------------------
Telephone | 218-640-7368
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------