Provider Demographics
NPI:1174763205
Name:PHILLIPS, KRISTEN R (LMT)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:R
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 LAUREL AVE
Mailing Address - Street 2:SUITE #1
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04210-5780
Mailing Address - Country:US
Mailing Address - Phone:207-576-4320
Mailing Address - Fax:
Practice Address - Street 1:17 LAUREL AVE
Practice Address - Street 2:SUITE #1
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-5780
Practice Address - Country:US
Practice Address - Phone:207-576-4320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-02
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT1974174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist