Healthcare Provider Details

I. General information

NPI: 1376231043
Provider Name (Legal Business Name): TRUEWAY PHLEBOTOMY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2023
Last Update Date: 05/01/2023
Certification Date: 04/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 E 87TH ST STE 100
CHICAGO IL
60617-2706
US

IV. Provider business mailing address

1750 E 87TH ST STE 100
CHICAGO IL
60617-2706
US

V. Phone/Fax

Practice location:
  • Phone: 773-577-0246
  • Fax:
Mailing address:
  • Phone: 773-577-0246
  • 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: RUTHIE CONSUELA NTANDJA
Title or Position: OWNER/PHLEBOTOMIST
Credential: CPT
Phone: 773-577-0246