Individual
WILLIAM PHILLIPS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
630 E RIVER ST, ELYRIA, OH 44035-5902
(440) 329-7596
Mailing address
3452 TUTTLE AVE, CLEVELAND, OH 44111-3027
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
RN.456208
OH
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
APRN.CNP.0028421
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
APRN.CNP.0028421
APRN LICENSE
OH
01
—
RN.456208
RN LICENSE
OH
Enumeration date
12/09/2020
Last updated
02/19/2021
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