Provider Demographics
NPI:1588699169
Name:PHILLIPS, LINDA M (FNP-C)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:M
Last Name:PHILLIPS
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Gender:F
Credentials:FNP-C
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Mailing Address - Street 1:N17W24100 RIVERWOOD DR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-1177
Mailing Address - Country:US
Mailing Address - Phone:262-928-4100
Mailing Address - Fax:262-928-5835
Practice Address - Street 1:240 MAPLE AVE
Practice Address - Street 2:DN GREENWALD CENTER
Practice Address - City:MUKWONAGO
Practice Address - State:WI
Practice Address - Zip Code:53149-8475
Practice Address - Country:US
Practice Address - Phone:262-928-1900
Practice Address - Fax:262-363-1949
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2015-05-29
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Provider Licenses
StateLicense IDTaxonomies
WI1832 033363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000040160Medicare Oscar/Certification