MEDICARE: GWENDOLEN PHIPPS RN

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	163W00000X	Registered Nurse	948378	TX

General Provider Information

NPI Number	:	1245162940
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GWENDOLEN PHIPPS RN

Provider Business Mailing Address
First Line	:	1105 WESSEX DR
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76712-4101
Country	:	US
Telephone Number	:	419-302-4751
Fax Number	:

Provider Business Practice Location Address
First Line	:	7125 NEW SANGER AVE
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76712-4053
Country	:	US
Telephone Number	:	254-399-5400
Fax Number	:

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

Provider Enumeration Date	:	05/29/2026
Last Update Date	:	05/29/2026

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