Individual
JENNIFER ELIZABETH PHILLIPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
560 W MITCHELL ST STE 400, PETOSKEY, MI 49770-2274
(231) 330-3246
Mailing address
560 W MITCHELL ST STE 400, PETOSKEY, MI 49770-2274
(231) 487-2490
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
5601003293
MI
363AM0700X
Medical Physician Assistant
Primary
PA10004815
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0039572
LABOR AND INDUSTRIES#
WA
05
—
1366580227
—
MI
01
—
4571LE
BLUE SHIELD
WA
05
—
8436487
—
WA
01
—
US7122654
AETNA SPECIALIST PIN
WA
Enumeration date
02/02/2007
Last updated
02/07/2019
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