Provider Demographics
NPI:1336986512
Name:PRENTICE, KATRINA MONIQUE (PHLEBOTOMIST)
Entity type:Individual
Prefix:MS
First Name:KATRINA
Middle Name:MONIQUE
Last Name:PRENTICE
Suffix:
Gender:F
Credentials:PHLEBOTOMIST
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Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 STATE HIGHWAY 121 STE 300
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75056-5157
Mailing Address - Country:US
Mailing Address - Phone:888-567-2238
Mailing Address - Fax:
Practice Address - Street 1:4400 STATE HIGHWAY 121 STE 300
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75056-5157
Practice Address - Country:US
Practice Address - Phone:888-567-2238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-13
Last Update Date:2024-07-13
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy