Healthcare Provider Details

I. General information

NPI: 1336926187
Provider Name (Legal Business Name): NYTISHA DAVIS PHLEBOTOMIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2023
Last Update Date: 02/28/2024
Certification Date: 02/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2942 N 24TH ST STE 114
PHOENIX AZ
85016-7849
US

IV. Provider business mailing address

2942 N 24TH ST STE 114
PHOENIX AZ
85016-7849
US

V. Phone/Fax

Practice location:
  • Phone: 866-467-5227
  • Fax:
Mailing address:
  • Phone: 866-467-5227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: