Healthcare Provider Details

I. General information

NPI: 1922881036
Provider Name (Legal Business Name): AMY L ARNOLD PHLEBOTOMIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2023
Last Update Date: 08/14/2023
Certification Date: 08/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2529 MAR RUTH DR
LAFAYETTE IN
47905-7809
US

IV. Provider business mailing address

2529 MAR RUTH DR
LAFAYETTE IN
47905-7809
US

V. Phone/Fax

Practice location:
  • Phone: 607-343-6438
  • Fax: 765-807-3050
Mailing address:
  • Phone: 607-343-6438
  • Fax: 765-807-3050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2472E0500X
TaxonomyEEG Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: