02D2156818 CLIA NUMBER - CHRISTINE BAILES, LLC DBA PINNACLE NEUROLOGY & INFUSION

Laboratory Demographics

CLIA Number: 02D2156818

Facility Name: CHRISTINE BAILES, LLC DBA PINNACLE NEUROLOGY & INFUSION

Facility Address:
3505 E MERIDIAN PARK LOOP, SUITE 100
WASILLA, AK
ZIP 99654
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Facility Phone Number: 907 864-0022

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1841686201

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	02D2156818
LAB Type	Physician Office
Facility Name	CHRISTINE BAILES, LLC DBA PINNACLE NEUROLOGY & INFUSION
Street	3505 E MERIDIAN PARK LOOP, SUITE 100
City	WASILLA
State	AK
ZIP	99654
Phone	907 864-0022
CertificateType	4
CertificateEffectiveDate	10/25/2022
CertificateExpirationDate	10/24/2024
FacilityType	Waiver

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