MEDICARE: CANDACE DENISE 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	363LF0000X	Family Nurse Practitioner	23201104814	MI

General Provider Information

NPI Number	:	1487334801
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CANDACE DENISE PHILLIPS

Provider Business Mailing Address
First Line	:	15278 BELMONT AVE
Second Line	:
City	:	ALLEN PARK
State	:	MI
Zip	:	48101-1710
Country	:	US
Telephone Number	:	313-623-4590
Fax Number	:

Provider Business Practice Location Address
First Line	:	5816 N SHELDON RD
Second Line	:
City	:	CANTON
State	:	MI
Zip	:	48187-3153
Country	:	US
Telephone Number	:	734-307-0037
Fax Number	:

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

Provider Enumeration Date	:	07/20/2023
Last Update Date	:	02/06/2025

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Directions to “ CANDACE DENISE PHILLIPS ” Practice Location

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