02D2089149 CLIA NUMBER - ALASKA FUNCTIONAL MEDICINE & SPA

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Laboratory Demographics

CLIA Number: 02D2089149

Facility Name: ALASKA FUNCTIONAL MEDICINE & SPA

Facility Address:
11260 OLD SEWARD HWY, STE 104
ANCHORAGE, AK
ZIP 99515
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Facility Phone Number: 907 375-9395

Facility Type: Physician Office

Certificate Type: Certificate of Compliance

NPI Number: 1649705583

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	02D2089149
LAB Type	Physician Office
Facility Name	ALASKA FUNCTIONAL MEDICINE & SPA
Street	11260 OLD SEWARD HWY, STE 104
City	ANCHORAGE
State	AK
ZIP	99515
Phone	907 375-9395
CertificateType	2
CertificateEffectiveDate	7/26/2022
CertificateExpirationDate	7/25/2024
FacilityType	Compliance

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This page was last updated on: 4/23/2024