Basic Information
| Provider Information | |||||||||
| NPI: | 1194961581 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PHILLIPS | ||||||||
| FirstName: | PATTY | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | RN RNFA CNOR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6475 S YALE AVE STE 301 | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741367815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9184949300 | ||||||||
| FaxNumber: | 9184949324 | ||||||||
| Practice Location | |||||||||
| Address1: | 6475 S YALE AVE STE 301 | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741367815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9184949300 | ||||||||
| FaxNumber: | 9184949324 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/06/2009 | ||||||||
| LastUpdateDate: | 02/25/2009 | ||||||||
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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 | 163WM0705X | R0019432 | OK | Y | Nursing Service Providers | Registered Nurse | Medical-Surgical |
No ID Information.