Provider Demographics
NPI:1073284998
Name:PHILLIPS, EARNESTYNE CELESTE
Entity type:Individual
Prefix:
First Name:EARNESTYNE
Middle Name:CELESTE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1869 HASTINGS AVE
Mailing Address - Street 2:
Mailing Address - City:EAST CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44112-2025
Mailing Address - Country:US
Mailing Address - Phone:216-673-9876
Mailing Address - Fax:
Practice Address - Street 1:1869 HASTINGS AVE
Practice Address - Street 2:
Practice Address - City:EAST CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44112-2025
Practice Address - Country:US
Practice Address - Phone:216-673-9876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty