Provider Demographics
NPI:1912581059
Name:PEDIATRIC PHLEBOTOMY ENHANCED LLC
Entity Type:Organization
Organization Name:PEDIATRIC PHLEBOTOMY ENHANCED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:L
Authorized Official - Last Name:DELONEY
Authorized Official - Suffix:
Authorized Official - Credentials:CPT
Authorized Official - Phone:612-594-8844
Mailing Address - Street 1:1666 WALNUT LN
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-2521
Mailing Address - Country:US
Mailing Address - Phone:612-594-8844
Mailing Address - Fax:
Practice Address - Street 1:1666 WALNUT LN
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-2521
Practice Address - Country:US
Practice Address - Phone:612-594-8844
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-05
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty