Individual
JOHN MARK PHILLIPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
1100 KANSAS AVE, SUITE A, MODESTO, CA 95351-1596
(209) 558-7475
(209) 558-4042
Mailing address
1100 KANSAS AVE, SUITE A, MODESTO, CA 95351-1596
(209) 558-7475
(209) 558-4042
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
538019
CA
Other
Enumeration date
11/08/2007
Last updated
11/08/2007
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