Basic Information
| Provider Information | |||||||||
| NPI: | 1245207240 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PHILLIPS | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 LOTHROP ST | ||||||||
| Address2: | FORBES TOWER SUITE 9055 | ||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152132536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4126478384 | ||||||||
| FaxNumber: | 4126474486 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 W BERKELEY ST | ||||||||
| Address2: | |||||||||
| City: | UNIONTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 154015514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7244376730 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2006 | ||||||||
| LastUpdateDate: | 07/23/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | RN-281570-L | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.