Provider Demographics
NPI:1245070812
Name:PHILLIPS, SANDI ELIZABETH
Entity type:Individual
Prefix:
First Name:SANDI
Middle Name:ELIZABETH
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11700 STATE ROUTE 644
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:44427-9717
Mailing Address - Country:US
Mailing Address - Phone:330-507-4678
Mailing Address - Fax:
Practice Address - Street 1:10972 MECHANICSTOWN RD
Practice Address - Street 2:
Practice Address - City:HANOVERTON
Practice Address - State:OH
Practice Address - Zip Code:44423-9782
Practice Address - Country:US
Practice Address - Phone:330-507-4678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide