Provider Demographics
NPI:1285188938
Name:PHILLIPS, ALLISON L (NP)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:L
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4318 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60609-3701
Mailing Address - Country:US
Mailing Address - Phone:773-285-9304
Mailing Address - Fax:
Practice Address - Street 1:2460 22ND ST.
Practice Address - Street 2:BUILDING 90, 4TH FLOOR
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110
Practice Address - Country:US
Practice Address - Phone:628-206-8524
Practice Address - Fax:628-206-4565
Is Sole Proprietor?:No
Enumeration Date:2016-08-11
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209014239363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health