Provider Demographics
NPI:1447433701
Name:PHILLIPS, PAULETTE R (RN)
Entity type:Individual
Prefix:MRS
First Name:PAULETTE
Middle Name:R
Last Name:PHILLIPS
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 1:5865 COLUMBUS RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44641-9266
Mailing Address - Country:US
Mailing Address - Phone:330-875-0836
Mailing Address - Fax:
Practice Address - Street 1:5865 COLUMBUS RD.
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:OH
Practice Address - Zip Code:44641-9266
Practice Address - Country:US
Practice Address - Phone:330-875-0836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-10
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN258293163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse