=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497322002
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TRACY WILLIAMS PHLEBOTOMIST
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/10/2021
-----------------------------------------------------
Last Update Date | 06/10/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 126 FOXTAIL LN
-----------------------------------------------------
City | LITTLETON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27850-9642
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-608-1307
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 126 FOXTAIL LN
-----------------------------------------------------
City | LITTLETON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27850-9642
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-608-1307
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 246R00000X
-----------------------------------------------------
Taxonomy Name | Pathology Technician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------