Individual
TRACI N PHILLIPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
3000 MACK RD, STE 120, FAIRFIELD, OH 45014-5335
(513) 682-6975
(513) 682-6976
Mailing address
3000 MACK RD, STE 120, FAIRFIELD, OH 45014-5335
(513) 682-6975
(513) 682-6976
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
COA.13933-NP
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0079955
—
OH
Enumeration date
10/19/2012
Last updated
05/03/2013
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