Healthcare Provider Details

I. General information

NPI: 1396341061
Provider Name (Legal Business Name): SHELTON PROFESSIONAL PHLEBOTOMY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2020
Last Update Date: 12/10/2020
Certification Date: 12/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 RUBLEIN ST STE C
MARQUETTE MI
49855-4060
US

IV. Provider business mailing address

1311 S STEPHENSON AVE STE 3
IRON MOUNTAIN MI
49801-4159
US

V. Phone/Fax

Practice location:
  • Phone: 313-953-8768
  • Fax:
Mailing address:
  • Phone: 906-239-6830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MRS. TIFFANI NICOLE WELZIN
Title or Position: ASSISTANT OPERATIONS MANAGER
Credential: PHLEB
Phone: 313-953-8768