Provider Demographics
NPI:1215791124
Name:PHILLIPS, MEGHAN AMELIA (IBCLC, RN)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:AMELIA
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:IBCLC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 MIRON DR
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-5020
Mailing Address - Country:US
Mailing Address - Phone:914-474-8815
Mailing Address - Fax:
Practice Address - Street 1:15 MIRON DR
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-5020
Practice Address - Country:US
Practice Address - Phone:914-474-8815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY727433163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant