Healthcare Provider Details

I. General information

NPI: 1851068357
Provider Name (Legal Business Name): VENI-PHLEB ELITE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2021
Last Update Date: 05/22/2023
Certification Date: 05/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9030 WESLEYAN RD # 207
INDIANAPOLIS IN
46268-3110
US

IV. Provider business mailing address

9030 WESLEYAN RD # 207
INDIANAPOLIS IN
46268-3110
US

V. Phone/Fax

Practice location:
  • Phone: 260-217-3187
  • Fax:
Mailing address:
  • Phone: 260-217-3187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State

VIII. Authorized Official

Name: WILLIA TUBBS
Title or Position: EXECUTIVE DIRECTOR
Credential: CCMA
Phone: 260-217-3187