MEDICARE: CLARONDA CAMPBELL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246RP1900X	Phlebotomy Technician	37376291	TX

General Provider Information

NPI Number	:	1093437998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLARONDA CAMPBELL

Provider Business Mailing Address
First Line	:	1301 JUSTIN RD STE 201
Second Line	:
City	:	LEWISVILLE
State	:	TX
Zip	:	75077-2183
Country	:	US
Telephone Number	:	972-836-9442
Fax Number	:

Provider Business Practice Location Address
First Line	:	1301 JUSTIN RD STE 201
Second Line	:
City	:	LEWISVILLE
State	:	TX
Zip	:	75077-2183
Country	:	US
Telephone Number	:	972-836-9442
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2022
Last Update Date	:	09/16/2022

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Directions to “ CLARONDA CAMPBELL ” Practice Location

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