MEDICARE: MS. NIKKI MARIE MONEYMAKER PHLEBOTOMIST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246RP1900X	Phlebotomy Technician		IN

General Provider Information

NPI Number	:	1255052924
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NIKKI MARIE MONEYMAKER PHLEBOTOMIST

Provider Business Mailing Address
First Line	:	3831 S EWING ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46237-1258
Country	:	US
Telephone Number	:	317-514-2095
Fax Number	:

Provider Business Practice Location Address
First Line	:	3831 S EWING ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46237-1258
Country	:	US
Telephone Number	:	317-514-2095
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2022
Last Update Date	:	09/09/2022

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