Provider Demographics
NPI:1962807800
Name:PHILLIPS, YVONNE (RN)
Entity type:Individual
Prefix:
First Name:YVONNE
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1706 BERRY LN
Mailing Address - Street 2:
Mailing Address - City:DISTRICT HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20747-1824
Mailing Address - Country:US
Mailing Address - Phone:517-410-1384
Mailing Address - Fax:
Practice Address - Street 1:DC VETERANS AFFAIRS MEDICAL CTR
Practice Address - Street 2:50 IRVINGTON ST. NW
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20422-0001
Practice Address - Country:US
Practice Address - Phone:202-745-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-04
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR213619163W00000X
MI4704289399163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse