Provider Demographics
NPI:1144644410
Name:PHILLIPS, LYNNE (RN)
Entity type:Individual
Prefix:
First Name:LYNNE
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 N. HAMILTON STREETQ
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTON
Mailing Address - State:SC
Mailing Address - Zip Code:29697
Mailing Address - Country:US
Mailing Address - Phone:864-847-7311
Mailing Address - Fax:864-847-3532
Practice Address - Street 1:804 N. HAMILTON STREET
Practice Address - Street 2:
Practice Address - City:WILLIAMSTON
Practice Address - State:SC
Practice Address - Zip Code:29697
Practice Address - Country:US
Practice Address - Phone:864-847-7311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-07
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC44030163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool