Healthcare Provider Details

I. General information

NPI: 1467032722
Provider Name (Legal Business Name): BIANCA BLACK PHLEBOTOMIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2021
Last Update Date: 04/19/2021
Certification Date: 04/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1942 PENFIELD ST
PHILADELPHIA PA
19138-2715
US

IV. Provider business mailing address

1942 PENFIELD ST
PHILADELPHIA PA
19138-2715
US

V. Phone/Fax

Practice location:
  • Phone: 267-266-1696
  • Fax:
Mailing address:
  • Phone: 267-266-1696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License Number
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: