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NPI Code Detail

MEDICARE: JO ELLA LEE PHILLIPS PA-C

MEDICARE: JO ELLA LEE PHILLIPS PA-C
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
1363A00000XPhysician AssistantPA.PA:60312122WA

General Provider Information

NPI Number : 1942545710
Entity Type Code : Individual
Provider Name (Legal Business Name) : JO ELLA LEE PHILLIPS PA-C
Provider Business Mailing Address
First Line : 1313 N 13TH AVE
Second Line :
City : WALLA WALLA
State : WA
Zip : 99362-8817
Country : US
Telephone Number : 208-284-0999
Fax Number :
Provider Business Practice Location Address
First Line : 1313 N 13TH AVE
Second Line :
City : WALLA WALLA
State : WA
Zip : 99362-8817
Country : US
Telephone Number : 208-284-0999
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/06/2012
Last Update Date : 12/06/2012

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Directions to “ JO ELLA LEE PHILLIPS PA-C” Practice Location

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