Healthcare Provider Details

I. General information

NPI: 1053022509
Provider Name (Legal Business Name): ENVEINA SERVICE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2022
Last Update Date: 06/08/2023
Certification Date: 06/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 OLD OXFORD RD STE F
DURHAM NC
27704-8779
US

IV. Provider business mailing address

1308 BENT WILLOW DR
DURHAM NC
27704-1969
US

V. Phone/Fax

Practice location:
  • Phone: 919-638-5550
  • Fax:
Mailing address:
  • Phone: 919-638-5550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KAWANIA MCDUFFIE
Title or Position: PHLEBOTOMIST
Credential: CPI, CPT, AA
Phone: 919-638-5550