MEDICARE: LASHONDA MANNING PHLEBOTOMIST

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		MI

General Provider Information

NPI Number	:	1376125955
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LASHONDA MANNING PHLEBOTOMIST

Provider Business Mailing Address
First Line	:	3314 RAVENNA DR
Second Line	:
City	:	AUBURN HILLS
State	:	MI
Zip	:	48326-1054
Country	:	US
Telephone Number	:	586-522-6836
Fax Number	:

Provider Business Practice Location Address
First Line	:	3314 RAVENNA DR
Second Line	:
City	:	AUBURN HILLS
State	:	MI
Zip	:	48326-1054
Country	:	US
Telephone Number	:	586-522-6836
Fax Number	:

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

Provider Enumeration Date	:	04/23/2021
Last Update Date	:	04/23/2021

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