Individual
GWYNETH BRENNA NELL PHILLIPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BA
Contact information
Practice address
360 PEAK ONE DR STE 180, FRISCO, CO 80443-5948
(970) 668-3633
Mailing address
518 BRIAN AVE, SILVERTHORNE, CO 80497-1901
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
108755
IA
2255A2300X
Athletic Trainer
Primary
AT.0002698
CO
246ZC0007X
Surgical Assistant
SA.0003217
CO
Other
Enumeration date
08/06/2019
Last updated
02/05/2026
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