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General NPI Number Information
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NPI Number | 1568049740
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Entity Type | Individual
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Provider Name | TISHA STEWART CERTIFIED PHLEBOTOMY
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Gender | Female
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Dates
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Enumeration Date | 03/25/2021
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Last Update Date | 06/15/2021
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Provider Practice Location Address
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Address Line | 920 S MAIN ST STE E
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City | BLACKSTONE
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State | VA
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Zip | 23824-2648
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Country | US
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Telephone | 804-721-0943
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Fax |
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Provider Business Mailing Address
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Address Line | 920 S MAIN ST STE E
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City | BLACKSTONE
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State | VA
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Zip | 23824-2648
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Country | US
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Telephone | 804-721-0943
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 202K00000X
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Taxonomy Name | Phlebology Physician
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License Number | 671228110014
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 246RP1900X
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Taxonomy Name | Phlebotomy Technician
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License Number | 671228110014
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License Number State | VA
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