Healthcare Provider Details

I. General information

NPI: 1063344513
Provider Name (Legal Business Name): MYISA CARDRIA SEYMORE PBT (ASCP)
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10171 N 19TH AVE STE 10
PHOENIX AZ
85021-1940
US

IV. Provider business mailing address

10171 N 19TH AVE STE 10
PHOENIX AZ
85021-1940
US

V. Phone/Fax

Practice location:
  • Phone: 623-463-7145
  • Fax:
Mailing address:
  • Phone: 623-463-7145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number62536
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: