03D2298273 CLIA NUMBER - MIND-BODY CONNECTIONS PLLC

Laboratory Demographics

CLIA Number: 03D2298273

Facility Name: MIND-BODY CONNECTIONS PLLC

Facility Address:
2227 W BASELINE RD STE 105
TEMPE, AZ
ZIP 85283
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Facility Phone Number: 602 980-8703

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1962173252

Taxonomy: 363LP0808X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	03D2298273
LAB Type	Practitioner Other
Facility Name	MIND-BODY CONNECTIONS PLLC
Street	2227 W BASELINE RD STE 105
City	TEMPE
State	AZ
ZIP	85283
Phone	602 980-8703
CertificateType	4
CertificateEffectiveDate	1/31/2024
CertificateExpirationDate	1/30/2026
FacilityType	Waiver

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