Healthcare Provider Details

I. General information

NPI: 1366180770
Provider Name (Legal Business Name): PATRICIA DENISE GAMBLE PHLEBOTOMY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2022
Last Update Date: 05/25/2022
Certification Date: 05/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 TALLWOOD DR
BATON ROUGE LA
70816-1434
US

IV. Provider business mailing address

1555 TALLWOOD DR
BATON ROUGE LA
70816-1434
US

V. Phone/Fax

Practice location:
  • Phone: 251-623-2385
  • Fax:
Mailing address:
  • Phone: 251-623-2385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number22981
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: