02D2097548 CLIA NUMBER - KIMBERLY J WONDERLICH DERMATOLOGY, LLC

Laboratory Demographics

  • CLIA Code: 02D2097548
  • Facility Name: KIMBERLY J WONDERLICH DERMATOLOGY, LLC
  • Facility Address: 2775 COLLEGE RD
    FAIRBANKS, AK
    ZIP 99709
  • Facility Phone: 907 456-1979
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: DR. KIMBERLY J. WONDERLICH
  • NPI Number: 1346211505
  • Taxonomy: 207N00000X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 02D2097548
LAB Type Physician Office
Facility Name KIMBERLY J WONDERLICH DERMATOLOGY, LLC
Street 2775 COLLEGE RD
City FAIRBANKS
State AK
ZIP 99709
Phone 907 456-1979
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 6/18/2025
Certificate Expiration Date 6/17/2027
Facility Type Physician Office
Lab Director DR. KIMBERLY J. WONDERLICH

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This page was last updated on: 9/29/2025