Provider Demographics
NPI:1174765069
Name:PHILLIPS, MARSHA LYNN (LPN)
Entity type:Individual
Prefix:MRS
First Name:MARSHA
Middle Name:LYNN
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8897 WASHINGTON WATERLOO RD NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON COURT HOUSE
Mailing Address - State:OH
Mailing Address - Zip Code:43160-9326
Mailing Address - Country:US
Mailing Address - Phone:740-437-6928
Mailing Address - Fax:
Practice Address - Street 1:8897 WASHINTON-WATERLOO RD NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON COURT HOUSE
Practice Address - State:OH
Practice Address - Zip Code:43160-9326
Practice Address - Country:US
Practice Address - Phone:740-437-6928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-24
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.091031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse