Individual
MRS. MARY LEE PHILLIPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
A.P.R.N., F.N.P.
Contact information
Practice address
903 S ADAMS ST, RITZVILLE, WA 99169-2227
(509) 659-1200
Mailing address
903 S ADAMS ST, RITZVILLE, WA 99169-2227
(509) 659-1200
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
26461.0975
WY
363LF0000X
Family Nurse Practitioner
33320
WV
363LF0000X
Family Nurse Practitioner
Primary
AP61557121
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001721127
BCBS SERVICE NUMBER
WV
05
—
7103229000
—
WV
01
—
P00265315
RAILROAD MEDICARE
WV
Enumeration date
10/03/2006
Last updated
11/20/2024
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