Provider Demographics
NPI:1811904956
Name:CORAM, PHILLIP MICHAEL (RN)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:MICHAEL
Last Name:CORAM
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30434 N PALO BREA DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85262-5401
Mailing Address - Country:US
Mailing Address - Phone:480-473-2777
Mailing Address - Fax:480-275-8086
Practice Address - Street 1:30434 N PALO BREA DR
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85262-5401
Practice Address - Country:US
Practice Address - Phone:480-473-2777
Practice Address - Fax:480-275-8086
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN080406163WS0121X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0121XNursing Service ProvidersRegistered NursePlastic Surgery