MEDICARE: ANDREA R PHILLIPS NP

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	363LF0000X	Family Nurse Practitioner	R127440	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093821977
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA R PHILLIPS NP

Provider Business Mailing Address
First Line	:	9440 PENNSYLVANIA AVE
Second Line	:	#160
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20772-3659
Country	:	US
Telephone Number	:	301-888-2233
Fax Number	:	301-888-9133

Provider Business Practice Location Address
First Line	:	23140 MOAKLEY ST STE 4
Second Line	:
City	:	LEONARDTOWN
State	:	MD
Zip	:	20650-2923
Country	:	US
Telephone Number	:	301-997-1029
Fax Number	:	301-997-1489

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

Provider Enumeration Date	:	08/22/2006
Last Update Date	:	02/16/2023

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Directions to “ ANDREA R PHILLIPS NP” Practice Location

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