Provider Demographics
NPI:1215677240
Name:PHILLIPS, FANNITA
Entity type:Individual
Prefix:
First Name:FANNITA
Middle Name:
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 1:305 FM 517 RD E UNIT F
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:TX
Mailing Address - Zip Code:77539-8643
Mailing Address - Country:US
Mailing Address - Phone:409-877-6466
Mailing Address - Fax:409-449-6442
Practice Address - Street 1:305 FM 517 RD E UNIT F
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:TX
Practice Address - Zip Code:77539-8643
Practice Address - Country:US
Practice Address - Phone:409-877-6466
Practice Address - Fax:409-449-6442
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-29
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy