Organization
JACK OF ALL STIXX
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DETAVIA KENAN (OWNER)
(336) 303-0587
Entity
Organization
Contact information
Practice address
2 CENTERVIEW DR STE 64, GREENSBORO, NC 27407-3708
(336) 303-0587
Mailing address
555 WHISTLING SWAN DR, GREENSBORO, NC 27455-1535
Taxonomy
Speciality
Code
Description
License number
State
246RP1900X
Phlebotomy Technician
Primary
—
—
253Z00000X
In Home Supportive Care Agency
—
—
Other
Enumeration date
09/03/2024
Last updated
09/03/2024
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