Healthcare Provider Details

I. General information

NPI: 1558967844
Provider Name (Legal Business Name): JAMIE LYNN SHELTON PHLEB
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2020
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 TaxonomyN
Taxonomy Code246RM2200X
TaxonomyMedical Laboratory Technician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR1100X
TaxonomyResearch Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: