Individual
JEANNINE PAMELA PHILLIPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1415 LILAC DR N STE 190, GOLDEN VALLEY, MN 55422-4544
(763) 267-8701
Mailing address
1415 LILAC DR N STE 190, GOLDEN VALLEY, MN 55422-4544
(763) 267-8701
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
10348
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
139989
UCARE
MN
01
—
154N5PH
BCBSM
MN
05
—
178452100
—
MN
01
—
HP85889
HEALTH PARTNERS
MN
01
—
P00474995
RR MEDICARE
MN
Enumeration date
11/14/2007
Last updated
11/11/2019
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