Provider Demographics
NPI:1962250167
Name:SELLERS, LARISHA LYNETTE (PHLEBOTOMIST, DOT)
Entity type:Individual
Prefix:
First Name:LARISHA
Middle Name:LYNETTE
Last Name:SELLERS
Suffix:
Gender:F
Credentials:PHLEBOTOMIST, DOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2640 E LEAGUE CITY PKWY STE 104
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-3369
Mailing Address - Country:US
Mailing Address - Phone:713-517-6054
Mailing Address - Fax:
Practice Address - Street 1:2640 E LEAGUE CITY PKWY STE 104
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-3369
Practice Address - Country:US
Practice Address - Phone:713-517-6054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-11
Last Update Date:2024-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Multi-Specialty