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General NPI Number Information
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NPI Number | 1851157689
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Entity Type | Individual
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Provider Name | DONNA PAKULA LAB DIRECTOR
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Gender | Female
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Dates
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Enumeration Date | 02/28/2024
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Last Update Date | 02/28/2024
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Provider Practice Location Address
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Address Line | 1640 PALOMINO LANE
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86406
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Country | US
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Telephone | 815-210-8388
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Fax | 815-534-4063
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Provider Business Mailing Address
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Address Line | 7199 S KINGERY HWY STE 1080
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City | WILLOWBROOK
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State | IL
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Zip | 60527-5525
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Country | US
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Telephone | 815-210-8388
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Fax | 815-534-4063
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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 | 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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