Individual
MS. ETTA J PHILLIPS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS,RD,LD
Contact information
Practice address
1550 KIPLING DR, DAYTON, OH 45406-4227
(937) 275-7185
Mailing address
1550 KIPLING DR, DAYTON, OH 45406-4227
(937) 275-7185
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
Primary
1853
OH
Other
Enumeration date
09/16/2006
Last updated
07/08/2007
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