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NPI Code Detail

MEDICARE: DEBRA ANNE PHILLIPS FNP-BC

MEDICARE: DEBRA ANNE PHILLIPS FNP-BC
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
1363LF0000XFamily Nurse PractitionerNP-677AID

General Provider Information

NPI Number : 1366741019
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEBRA ANNE PHILLIPS FNP-BC
Provider Business Mailing Address
First Line : 1202 E LOCUST ST
Second Line :
City : EMMETT
State : ID
Zip : 83617-2715
Country : US
Telephone Number : 208-365-3561
Fax Number : 208-365-4176
Provider Business Practice Location Address
First Line : 1202 E LOCUST ST
Second Line :
City : EMMETT
State : ID
Zip : 83617-2715
Country : US
Telephone Number : 208-365-3561
Fax Number : 208-365-4176
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/21/2011
Last Update Date : 03/21/2011

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Directions to “ DEBRA ANNE PHILLIPS FNP-BC” Practice Location

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