Provider Demographics
NPI:1902122955
Name:PHILLIPS, ERNESTINE NMN (R,D,LD)
Entity Type:Individual
Prefix:MISS
First Name:ERNESTINE
Middle Name:NMN
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:R,D,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1026 JONES AVE
Mailing Address - Street 2:
Mailing Address - City:OAK HILL
Mailing Address - State:WV
Mailing Address - Zip Code:25901-2056
Mailing Address - Country:US
Mailing Address - Phone:304-469-7356
Mailing Address - Fax:
Practice Address - Street 1:1026 JONES AVE
Practice Address - Street 2:
Practice Address - City:OAK HILL
Practice Address - State:WV
Practice Address - Zip Code:25901-2056
Practice Address - Country:US
Practice Address - Phone:304-469-7356
Practice Address - Fax:304-250-7014
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-15
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV141133V00000X, 133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic