Provider Demographics
NPI:1598385643
Name:WELLINGTON, MELISSA (PHLEBOTOMY TECH)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:WELLINGTON
Suffix:
Gender:F
Credentials:PHLEBOTOMY TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 ADAMS PL APT 2
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:NJ
Mailing Address - Zip Code:07644-2966
Mailing Address - Country:US
Mailing Address - Phone:973-405-8977
Mailing Address - Fax:
Practice Address - Street 1:15 ADAMS PL APT 2
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:NJ
Practice Address - Zip Code:07644-2966
Practice Address - Country:US
Practice Address - Phone:973-405-8977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-18
Last Update Date:2020-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJW24015376450822OtherDRIVERS LICENSE