Provider Demographics
NPI:1700457801
Name:KRYPTONITE MOBILE LAB SERVICES
Entity Type:Organization
Organization Name:KRYPTONITE MOBILE LAB SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTIAL OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NOELLE
Authorized Official - Middle Name:THERESA
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-994-9869
Mailing Address - Street 1:7827 NW 39TH CT APT 1
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-3060
Mailing Address - Country:US
Mailing Address - Phone:954-994-9869
Mailing Address - Fax:866-817-9761
Practice Address - Street 1:7827 NW 39TH CT APT 1
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-3060
Practice Address - Country:US
Practice Address - Phone:954-994-9869
Practice Address - Fax:866-817-9761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Multi-Specialty