Provider Demographics
NPI:1992133797
Name:PHILLIPS, ALLISON (LVN)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11086 CATABA ST
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-4827
Mailing Address - Country:US
Mailing Address - Phone:760-669-9877
Mailing Address - Fax:
Practice Address - Street 1:11086 CATABA ST
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392-4827
Practice Address - Country:US
Practice Address - Phone:760-669-9877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-15
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN 254877164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse