MEDICARE: WANDA A PHILLIPS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency		MI

General Provider Information

NPI Number	:	1063379881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WANDA A PHILLIPS

Provider Business Mailing Address
First Line	:	21366 HALL RD UNIT 1028
Second Line	:
City	:	CLINTON TWP
State	:	MI
Zip	:	48038-1539
Country	:	US
Telephone Number	:	734-341-8392
Fax Number	:	586-552-5946

Provider Business Practice Location Address
First Line	:	21366 HALL RD UNIT 1028
Second Line	:
City	:	CLINTON TWP
State	:	MI
Zip	:	48038-1539
Country	:	US
Telephone Number	:	734-341-8392
Fax Number	:	586-552-5946

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/05/2026
Last Update Date	:	01/05/2026

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Directions to “ WANDA A PHILLIPS ” Practice Location

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