Provider Demographics
NPI:1447457387
Name:PHILLIPS, MICHELLE ANN (ARNP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ANN
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3002
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-0302
Mailing Address - Country:US
Mailing Address - Phone:360-414-2800
Mailing Address - Fax:360-414-2803
Practice Address - Street 1:1660 DELAWARE ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2310
Practice Address - Country:US
Practice Address - Phone:360-414-2800
Practice Address - Fax:360-414-2803
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30007727363L00000X, 363LW0102X
WARN00168417163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WARN00168417OtherWA STATE RN LICENSE
WA8945279OtherCRIME VICTIMS
WA9653718Medicaid
WAAP30007727OtherWA STATE ARNP LICENSE
WA0224120OtherLABOR & INDUSTRIES
WAAP30007727OtherWA STATE ARNP LICENSE