Healthcare Provider Details

I. General information

NPI: 1922736214
Provider Name (Legal Business Name): MANI&FLOW VENIPUNCTURE COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2022
Last Update Date: 08/12/2022
Certification Date: 08/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1880 N STATE ROUTE 50 STE 4
BOURBONNAIS IL
60914-4432
US

IV. Provider business mailing address

189 N QUINCY AVE
BRADLEY IL
60915-1841
US

V. Phone/Fax

Practice location:
  • Phone: 815-386-0981
  • Fax:
Mailing address:
  • Phone: 815-386-0981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. FLORENCE LANE
Title or Position: FOUNDER/CEO
Credential: CNA, CPT
Phone: 815-386-0981