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General NPI Number Information
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NPI Number | 1639981061
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Entity Type | Individual
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Provider Name | KRYSTAL PHILLIPS
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Gender | Female
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Dates
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Enumeration Date | 01/22/2025
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Last Update Date | 01/22/2025
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Provider Practice Location Address
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Address Line | 630 CHURCHMANS RD STE 100A
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City | NEWARK
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State | DE
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Zip | 19702-1943
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Country | US
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Telephone | 941-294-4050
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Fax |
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Provider Business Mailing Address
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Address Line | 7466 ALEXANDRA DR
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City | NEWARK
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State | DE
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Zip | 19702-8147
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Country | US
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Telephone | 302-535-4958
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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