Provider Demographics
NPI:1245931021
Name:NTANDJA, RUTHIE CONSUELA (PHLEBOTOMIST)
Entity type:Individual
Prefix:MRS
First Name:RUTHIE
Middle Name:CONSUELA
Last Name:NTANDJA
Suffix:
Gender:F
Credentials:PHLEBOTOMIST
Other - Prefix:
Other - First Name:RUTHIE
Other - Middle Name:CONSUELA
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1722 E 84TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60617-2203
Mailing Address - Country:US
Mailing Address - Phone:312-388-1235
Mailing Address - Fax:
Practice Address - Street 1:1750 E. 87TH ST
Practice Address - Street 2:SUITE 104
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617
Practice Address - Country:US
Practice Address - Phone:773-577-0246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-17
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL20-0997Y13246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy