Provider Demographics
NPI:1215722756
Name:PHILLIPS, ANITA MARIE
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:MARIE
Last Name:PHILLIPS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 E 154TH ST
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:IL
Mailing Address - Zip Code:60426-3326
Mailing Address - Country:US
Mailing Address - Phone:708-566-1768
Mailing Address - Fax:
Practice Address - Street 1:142 E 154TH ST
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:IL
Practice Address - Zip Code:60426-3326
Practice Address - Country:US
Practice Address - Phone:708-566-1768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041473762390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program