Provider Demographics
NPI:1558178186
Name:PHILLIPS, MICHAELA (APRN)
Entity type:Individual
Prefix:
First Name:MICHAELA
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1351 SOUTH COUNTY TRAIL
Mailing Address - Street 2:SUITE 301 BUILDING 3
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818
Mailing Address - Country:US
Mailing Address - Phone:401-398-0860
Mailing Address - Fax:401-398-0861
Practice Address - Street 1:1351 SOUTH COUNTY TRAIL
Practice Address - Street 2:SUITE 301 BUILDING 3
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818
Practice Address - Country:US
Practice Address - Phone:401-398-0860
Practice Address - Fax:401-398-0861
Is Sole Proprietor?:No
Enumeration Date:2024-12-17
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RIAPRN04334363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily