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Medical Assistant-Phlebotomist Certification Application ...

DOH 651-007 March 2018 Medical Assistant-Phlebotomist Certification Application PacketContents: 1. 651-007 ..Contents List/SSN Information/Mailing Information ..1 page2. 651-008 .. Application Instructions pages3. 651-009 ..Credentialing page4. 651-010 .. Medical Assistant-Phlebotomist Certification Application ..5 pages5. RCW/WAC and Online Website Links ..1 pageImportant Social Security Number Information:You are required by state and federal law to provide a social security number with your Application . If you do not have a social security number at the time you send in this Application , please read, complete, and return this form with your Application .

Federal Centers for Medicare and Medicaid Services. The NPI is a 10 digit numeric identifier. If you have a NPI number, provide this on your application. Legal Name: List your full name: first, middle, and last. Definition of Legal Name: “Legal name” is the name appearing on your official

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  Applications, Medical, Medicare, Certifications, Assistant, Phlebotomist, Medical assistant phlebotomist certification application

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