=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568385805
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TAQUELLA HUBERT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/03/2026
-----------------------------------------------------
Last Update Date | 08/03/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5343 BELLEVILLE CROSSING ST # 1962
-----------------------------------------------------
City | BELLEVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62226-3108
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 844-687-6120
-----------------------------------------------------
Fax | 844-226-7182
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5343 BELLEVILLE CROSSING ST # 1962
-----------------------------------------------------
City | BELLEVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62226-3108
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 844-687-6120
-----------------------------------------------------
Fax | 844-226-7182
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 246RP1900X
-----------------------------------------------------
Taxonomy Name | Phlebotomy Technician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------