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General NPI Number Information
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NPI Number | 1710370135
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Entity Type | Individual
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Provider Name | STEPHANIE PHILLIPS PA-C
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Gender | Female
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Dates
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Enumeration Date | 03/10/2015
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Last Update Date | 03/10/2015
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Provider Practice Location Address
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Address Line | 777 E ROUTE 70 # G-101
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City | MARLTON
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State | NJ
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Zip | 08053-2341
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Country | US
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Telephone | 856-983-9939
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Fax | 856-983-9936
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Provider Business Mailing Address
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Address Line | 777 E ROUTE 70 # G-101
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City | MARLTON
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State | NJ
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Zip | 08053-2341
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Country | US
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Telephone | 856-983-9939
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Fax | 856-983-9936
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 25MP00361800
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License Number State | NJ
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