03D2110608 CLIA NUMBER - MARY PASTERNACKI FAMILY HEALTHCARE, PLLC

Laboratory Demographics

  • CLIA Code: 03D2110608
  • Facility Name: MARY PASTERNACKI FAMILY HEALTHCARE, PLLC
  • Facility Address: 1016 W UNIVERSITY AVE, STE 206
    FLAGSTAFF, AZ
    ZIP 86001
  • Facility Phone: 928 266-1530
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: MARY A. PASTERNACKI
  • NPI Number: 1275690331
  • Taxonomy: 363LF0000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 03D2110608
LAB Type Practitioner Other
Facility Name MARY PASTERNACKI FAMILY HEALTHCARE, PLLC
Street 1016 W UNIVERSITY AVE, STE 206
City FLAGSTAFF
State AZ
ZIP 86001
Phone 928 266-1530
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/21/2024
Certificate Expiration Date 3/20/2026
Facility Type Practitioner Other
Lab Director MARY A. PASTERNACKI

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This page was last updated on: 3/20/2025