03D2202561 CLIA NUMBER - MD NP ADULT MEDICINE CLINIC

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Laboratory Demographics

CLIA Number: 03D2202561

Facility Name: MD NP ADULT MEDICINE CLINIC

Facility Address:
4721 N FIRST AVE
TUCSON, AZ
ZIP 85718
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Facility Phone Number: 520 440-6914

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1316375181

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	03D2202561
LAB Type	Practitioner Other
Facility Name	MD NP ADULT MEDICINE CLINIC
Street	4721 N FIRST AVE
City	TUCSON
State	AZ
ZIP	85718
Phone	520 440-6914
CertificateType	4
CertificateEffectiveDate	11/30/2022
CertificateExpirationDate	11/29/2024
FacilityType	Waiver

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