MEDICARE: MRS. EDLENA STARLING-LEE NPT

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	20-1183Y09	IL

General Provider Information

NPI Number	:	1508449620
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. EDLENA STARLING-LEE NPT

Provider Business Mailing Address
First Line	:	525 E 161ST PL
Second Line	:
City	:	SOUTH HOLLAND
State	:	IL
Zip	:	60473-1618
Country	:	US
Telephone Number	:	708-574-8045
Fax Number	:

Provider Business Practice Location Address
First Line	:	525 E 161ST PL
Second Line	:
City	:	SOUTH HOLLAND
State	:	IL
Zip	:	60473-1618
Country	:	US
Telephone Number	:	708-574-8045
Fax Number	:

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

Provider Enumeration Date	:	05/05/2021
Last Update Date	:	05/05/2021

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