Provider Demographics
NPI:1235964651
Name:PHILLIPPS, MARISA A (RN)
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:A
Last Name:PHILLIPPS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4050 PIEDMONT PKWY
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-9458
Mailing Address - Country:US
Mailing Address - Phone:336-289-8648
Mailing Address - Fax:
Practice Address - Street 1:4050 PIEDMONT PKWY
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-9458
Practice Address - Country:US
Practice Address - Phone:336-289-8648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC196721163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse