MEDICARE: DOLORES ANN 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	363L00000X	Nurse Practitioner	28053858A	IN

General Provider Information

NPI Number	:	1811026909
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOLORES ANN PHILLIPS

Provider Business Mailing Address
First Line	:	6306 WAITE ST
Second Line	:
City	:	MERRILLVILLE
State	:	IN
Zip	:	46410-2854
Country	:	US
Telephone Number	:	219-884-1455
Fax Number	:

Provider Business Practice Location Address
First Line	:	5800 BROADWAY
Second Line	:	SUITES A-J
City	:	MERRILLVILLE
State	:	IN
Zip	:	46410-2601
Country	:	US
Telephone Number	:	219-884-9180
Fax Number	:	219-884-9280

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

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	01/19/2011

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Directions to “ DOLORES ANN PHILLIPS ” Practice Location

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