MEDICARE: MS. ANNEPHIA MICHELLE PROCTOR

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

General Provider Information

NPI Number	:	1174193742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANNEPHIA MICHELLE PROCTOR

Provider Business Mailing Address
First Line	:	11315 LORD BALTIMORE DR
Second Line	:
City	:	SWAN POINT
State	:	MD
Zip	:	20645
Country	:	US
Telephone Number	:	301-202-5198
Fax Number	:	240-427-3900

Provider Business Practice Location Address
First Line	:	11315 LORD BALTIMORE DR
Second Line	:
City	:	SWAN POINT
State	:	MD
Zip	:	20645
Country	:	US
Telephone Number	:	301-202-5198
Fax Number	:	240-427-3900

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

Provider Enumeration Date	:	06/28/2021
Last Update Date	:	06/28/2021

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