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General NPI Number Information
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NPI Number | 1790538742
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Entity Type | Individual
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Provider Name | REGINA MAURICE ETIM SPECIMEN COLLECTOR
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Gender | Female
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Dates
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Enumeration Date | 04/09/2024
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Last Update Date | 04/09/2024
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Provider Practice Location Address
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Address Line | 8300 BROADWAY STE A1
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City | MERRILLVILLE
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State | IN
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Zip | 46410-6285
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Country | US
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Telephone | 779-236-7071
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Fax |
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Provider Business Mailing Address
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Address Line | 1855 W 84TH DR APT G181
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City | MERRILLVILLE
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State | IN
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Zip | 46410-8424
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Country | US
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Telephone | 779-236-7071
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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 | 247ZC0005X
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Taxonomy Name | Clinical Laboratory Director (Non-physician)
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License Number |
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License Number State | NULL
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