Basic Information
| Provider Information | |||||||||
| NPI: | 1497898944 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PHILLIPS | ||||||||
| FirstName: | VICKY | ||||||||
| MiddleName: | A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4669 ESTES ST | ||||||||
| Address2: | |||||||||
| City: | WHEAT RIDGE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800333135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3039407997 | ||||||||
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| Practice Location | |||||||||
| Address1: | 280 EXEMPLA CIR | ||||||||
| Address2: | |||||||||
| City: | LAFAYETTE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800263370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037435855 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 163WX0200X | 86443 | CO | Y | Nursing Service Providers | Registered Nurse | Oncology |
ID Information
| ID | Type | State | Issuer | Description | 002419 | 01 | KAISER-COMMERCIAL NUMBER | OTHER |