Healthcare Provider Details

I. General information

NPI: 1396584785
Provider Name (Legal Business Name): PRECIOUS VENABLE CPT, MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2024
Last Update Date: 05/23/2024
Certification Date: 05/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3050 N 24TH ST
MILWAUKEE WI
53206-1103
US

IV. Provider business mailing address

3050 N 24TH ST
MILWAUKEE WI
53206-1103
US

V. Phone/Fax

Practice location:
  • Phone: 414-249-1304
  • Fax:
Mailing address:
  • Phone: 414-249-1304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License NumberW7J3A7F2
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: