Healthcare Provider Details

I. General information

NPI: 1093403321
Provider Name (Legal Business Name): ROSS MOBILE PHLEBOTOMY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2023
Last Update Date: 04/25/2023
Certification Date: 04/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 RIDGEWAY DR APT 6
DE PERE WI
54115-3690
US

IV. Provider business mailing address

2300 RIVERSIDE DR
GREEN BAY WI
54301-1900
US

V. Phone/Fax

Practice location:
  • Phone: 920-301-9022
  • Fax:
Mailing address:
  • Phone: 920-340-8058
  • Fax: 920-340-8059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State

VIII. Authorized Official

Name: RHONDA LORRAINE ROSS
Title or Position: PHLEBOTOMIST/OWNER
Credential: PBT-ASCP
Phone: 920-340-8058