Organization
WNUCARE
Active
Parent organization
NO
Other names
none
Organization subpart
Yes
Provider details
NPI number
Legal business name
NO
Authorized official
MS. JULIA LYNN PHILLIPS DTR (DIETETIC TECHNITION REGISTERED NUTR)
(618) 410-4236
Entity
Organization
Contact information
Practice address
301 EAST BROADWAY, ALTON, IL 62002-5280
(618) 470-4236
(618) 433-9090
Mailing address
1020 APT A ALTON POINT CIRCLE DRIVE, ALTON, IL 62002-5280
(618) 410-4236
(161) 833-9090
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
302R00000X
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5533PHIL
—
IL
Enumeration date
08/20/2010
Last updated
08/20/2010
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