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General NPI Number Information
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NPI Number | 1770211260
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Entity Type | Organization
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Legal Business Name | PHLEBO MOBILE LLC
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Dates
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Enumeration Date | 08/11/2022
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Last Update Date | 08/11/2022
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Provider Practice Location Address
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Address Line | 1305 HUTTON AVE
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City | FARMINGTON
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State | NM
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Zip | 87402-7601
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Country | US
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Telephone | 505-330-6953
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Fax | 505-258-4356
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Provider Business Mailing Address
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Address Line | 1305 HUTTON AVE
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City | FARMINGTON
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State | NM
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Zip | 87402-7601
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Country | US
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Telephone | 505-330-6953
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Fax | 505-258-4356
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR/NCPT
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Name | MISS HEATHER ROSE CHARLIE
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Credential | NCPT
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Telephone | 505-330-6953
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246RP1900X
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Taxonomy Name | Phlebotomy Technician
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License Number |
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License Number State |
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