03D2259209 CLIA NUMBER - BEVHION BOUDICA FAMILY HEALTHCARE, PLLC

Laboratory Demographics

CLIA Number: 03D2259209

Facility Name: BEVHION BOUDICA FAMILY HEALTHCARE, PLLC

Facility Address:
2323 E GREENLAW LN STE 7B
FLAGSTAFF, AZ
ZIP 86004
Get Directions

Facility Phone Number: 928 863-6673

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1891326872

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	03D2259209
LAB Type	Practitioner Other
Facility Name	BEVHION BOUDICA FAMILY HEALTHCARE, PLLC
Street	2323 E GREENLAW LN STE 7B
City	FLAGSTAFF
State	AZ
ZIP	86004
Phone	928 863-6673
CertificateType	4
CertificateEffectiveDate	5/3/2022
CertificateExpirationDate	5/2/2024
FacilityType	Waiver

Download Record

Export to text format icon Download this CLIA NUMBER record in Text format: Export

Export to text format icon Download this CLIA NUMBER record in Excel (CSV) format: Export

Export to text format icon Download this CLIA NUMBER record in XML format: Export

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