Individual
ANGELA PHILLIPS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2821 EAST LANCASTER AVENUE, FORT WORTH, TX 76103-7610
(312) 752-0106
Mailing address
4560 RANDOLPH ROAD, APT 112, CHARLOTTE, NC 28211
(312) 752-0106
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NA
NA
—
Enumeration date
11/23/2021
Last updated
11/23/2021
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