03D2198809 CLIA NUMBER - NORTHERN ARIZONA UNIVERSITY

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Laboratory Demographics

CLIA Number: 03D2198809

Facility Name: NORTHERN ARIZONA UNIVERSITY

Facility Address:
1706 S SAN FRANCISCO ST
FLAGSTAFF, AZ
ZIP 86001
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Facility Phone Number: 928 523-1040

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1639545007

Taxonomy: 363LP0200X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	03D2198809
LAB Type	Practitioner Other
Facility Name	NORTHERN ARIZONA UNIVERSITY
Street	1706 S SAN FRANCISCO ST
City	FLAGSTAFF
State	AZ
ZIP	86001
Phone	928 523-1040
CertificateType	4
CertificateEffectiveDate	11/4/2022
CertificateExpirationDate	11/3/2024
FacilityType	Waiver

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