Individual
MISS MARISA M PHILLIPS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
313 LARKIN ST, EAGLE, WI 53119-2233
(262) 613-5106
Mailing address
313 LARKIN ST, EAGLE, WI 53119-2233
(262) 613-5106
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
—
WI
163WH0200X
Home Health Registered Nurse
—
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4663031
PRIOR AUTHORIZATION NUMBE
WI
Enumeration date
03/12/2008
Last updated
03/12/2008
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