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General NPI Number Information
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NPI Number | 1639263650
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Entity Type | Individual
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Provider Name | MARY LEE PHILLIPS A.P.R.N., F.N.P.
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Gender | Female
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 903 S ADAMS ST
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City | RITZVILLE
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State | WA
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Zip | 99169-2227
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Country | US
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Telephone | 509-659-1200
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Fax |
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Provider Business Mailing Address
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Address Line | 903 S ADAMS ST
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City | RITZVILLE
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State | WA
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Zip | 99169-2227
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Country | US
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Telephone | 509-659-1200
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 26461.0975
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License Number State | WY
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP61557121
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 33320
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License Number State | WV
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