Healthcare Provider Details

I. General information

NPI: 1568385805
Provider Name (Legal Business Name): TAQUELLA HUBERT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5343 BELLEVILLE CROSSING ST # 1962
BELLEVILLE IL
62226-3108
US

IV. Provider business mailing address

5343 BELLEVILLE CROSSING ST # 1962
BELLEVILLE IL
62226-3108
US

V. Phone/Fax

Practice location:
  • Phone: 844-687-6120
  • Fax: 844-226-7182
Mailing address:
  • Phone: 844-687-6120
  • Fax: 844-226-7182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: