1124536438 NPI number — STEPHANIE HIRES PHILLIPS CRNP

Table of content: STEPHANIE HIRES PHILLIPS CRNP (NPI 1124536438)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124536438 NPI number — STEPHANIE HIRES PHILLIPS CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PHILLIPS
Provider First Name:
STEPHANIE
Provider Middle Name:
HIRES
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124536438
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/19/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
412 CREAMERY WAY STE 400
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EXTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19341-2551
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-594-7590
Provider Business Mailing Address Fax Number:
610-594-2625

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1240 WRIGHTS LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST CHESTER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19380-4252
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-431-1210
Provider Business Practice Location Address Fax Number:
610-594-2625
Provider Enumeration Date:
01/21/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  SP018398 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)