1245931021 NPI number — MRS. RUTHIE CONSUELA NTANDJA PHLEBOTOMIST

Table of content: MRS. RUTHIE CONSUELA NTANDJA PHLEBOTOMIST (NPI 1245931021)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245931021 NPI number — MRS. RUTHIE CONSUELA NTANDJA PHLEBOTOMIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NTANDJA
Provider First Name:
RUTHIE
Provider Middle Name:
CONSUELA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PHLEBOTOMIST
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HARRIS
Provider Other First Name:
RUTHIE
Provider Other Middle Name:
CONSUELA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1245931021
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1722 E 84TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60617-2203
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-388-1235
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1750 E. 87TH ST
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60617
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-577-0246
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/17/2023

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 246RP1900X , with the licence number:  20-0997Y13 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com