Individual
JACQUELINE PHILLIPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2595 S CIMARRON RD STE 107, LAS VEGAS, NV 89117-2697
(702) 328-5679
Mailing address
264 VIA CONTATA ST, HENDERSON, NV 89074-1415
(702) 328-5679
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN19485
NV
171M00000X
Case Manager/Care Coordinator
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1083191738
—
NV
Enumeration date
08/27/2019
Last updated
08/27/2019
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