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General NPI Number Information
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NPI Number | 1801579263
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Entity Type | Organization
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Legal Business Name | PHLEBTECH MOBILE DIAGNOSTICS
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Dates
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Enumeration Date | 08/10/2023
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Last Update Date | 08/14/2023
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Provider Practice Location Address
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Address Line | 372 MAPLE RD
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City | EAST AURORA
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State | NY
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Zip | 14052-1455
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Country | US
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Telephone | 919-339-7860
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Fax |
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Provider Business Mailing Address
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Address Line | 372 MAPLE RD
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City | EAST AURORA
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State | NY
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Zip | 14052-1455
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Country | US
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Telephone | 919-339-7860
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Fax |
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Authorized Official
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Title or Position | PHLEBOTOMIST
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Name | ERNESTINE SHANIKA BRYANT
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Credential | CPT, ASCP
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Telephone | 919-339-7860
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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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