Healthcare Provider Details

I. General information

NPI: 1407502453
Provider Name (Legal Business Name): YARLESHA JOHNSON PHLEBOTOMIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2022
Last Update Date: 03/10/2022
Certification Date: 03/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 E ERIE ST STE 525
CHICAGO IL
60611-2980
US

IV. Provider business mailing address

8518 S SAINT LAWRENCE AVE
CHICAGO IL
60619-6025
US

V. Phone/Fax

Practice location:
  • Phone: 847-236-2219
  • Fax:
Mailing address:
  • Phone: 312-286-1160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License NumberT3J8H7X2
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License NumberT3J8H7X2
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: