MEDICARE: MR. WILLIAM LANE PHILLIPS JR. ARNP

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	ARNP3058722	FL

General Provider Information

NPI Number	:	1689975161
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM LANE PHILLIPS JR. ARNP

Provider Business Mailing Address
First Line	:	2048 SE 16TH ST
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33990-6813
Country	:	US
Telephone Number	:	239-940-7403
Fax Number	:

Provider Business Practice Location Address
First Line	:	3424 FOWLER ST
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-7321
Country	:	US
Telephone Number	:	239-940-7403
Fax Number	:

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

Provider Enumeration Date	:	11/15/2010
Last Update Date	:	11/15/2010

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