Healthcare Provider Details

I. General information

NPI: 1225776438
Provider Name (Legal Business Name): PASSION MOBILE STICKS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2022
Last Update Date: 05/26/2022
Certification Date: 05/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 N SANGAMON ST STE 200
CHICAGO IL
60607-2201
US

IV. Provider business mailing address

159 N SANGAMON ST STE 200
CHICAGO IL
60607-2201
US

V. Phone/Fax

Practice location:
  • Phone: 183-357-2774
  • Fax:
Mailing address:
  • Phone: 183-357-2774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: REGINA LOGAN
Title or Position: CEO
Credential:
Phone: 833-572-7743