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General NPI Number Information
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NPI Number | 1942321609
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Entity Type | Individual
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Provider Name | JENNIFER LORRAINE PHILLIPS N.D.
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Gender | Female
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 41 W CHESTNUT AVE
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City | MERCHANTVILLE
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State | NJ
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Zip | 08109-2305
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Country | US
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Telephone | 856-488-7067
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Fax |
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Provider Business Mailing Address
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Address Line | 41 W CHESTNUT AVE
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City | MERCHANTVILLE
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State | NJ
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Zip | 08109-2305
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Country | US
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Telephone | 856-488-7067
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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 | 175F00000X
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Taxonomy Name | Naturopath
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License Number | 0990000126
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License Number State | VT
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