Healthcare Provider Details

I. General information

NPI: 1003745324
Provider Name (Legal Business Name): BONDED BY BLOOD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3632 LILAC RD
SOUTH BEND IN
46628-3852
US

IV. Provider business mailing address

3632 LILAC RD
SOUTH BEND IN
46628-3852
US

V. Phone/Fax

Practice location:
  • Phone: 574-514-8635
  • Fax:
Mailing address:
  • Phone: 574-514-8635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: SHAWNIECE WATSON
Title or Position: OWNER/EMPLOYEE
Credential: CPT
Phone: 574-514-8635