MEDICARE: ALLISON K PHILIPS BSN, MPH

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	163WX0200X	Oncology Registered Nurse	662872	NY
2	163WH0200X	Home Health Registered Nurse	662872	NY

General Provider Information

NPI Number	:	1710537147
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLISON K PHILIPS BSN, MPH

Provider Business Mailing Address
First Line	:	4262 GEMINI PATH
Second Line	:
City	:	LIVERPOOL
State	:	NY
Zip	:	13090-1937
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	97 PATRICIA DR
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13212-4272
Country	:	US
Telephone Number	:	315-409-3949
Fax Number	:

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

Provider Enumeration Date	:	09/17/2019
Last Update Date	:	09/17/2019

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