Provider Demographics
NPI:1568049740
Name:STEWART, TISHA (CERTIFIED PHLEBOTOMY)
Entity Type:Individual
Prefix:
First Name:TISHA
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:CERTIFIED PHLEBOTOMY
Other - Prefix:
Other - First Name:TISHA
Other - Middle Name:
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CPT
Mailing Address - Street 1:920 S MAIN ST STE E
Mailing Address - Street 2:
Mailing Address - City:BLACKSTONE
Mailing Address - State:VA
Mailing Address - Zip Code:23824-2648
Mailing Address - Country:US
Mailing Address - Phone:804-721-0943
Mailing Address - Fax:
Practice Address - Street 1:920 S MAIN ST STE E
Practice Address - Street 2:
Practice Address - City:BLACKSTONE
Practice Address - State:VA
Practice Address - Zip Code:23824-2648
Practice Address - Country:US
Practice Address - Phone:804-721-0943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-25
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA671228110014202K00000X, 246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
No202K00000XAllopathic & Osteopathic PhysiciansPhlebology