04D2271630 CLIA NUMBER - SHANNAN SOUZA APRN LLC

Laboratory Demographics

  • CLIA Code: 04D2271630
  • Facility Name: SHANNAN SOUZA APRN LLC
  • Facility Address: 5150A SR 247
    POTTSVILLE, AR
    ZIP 72858
  • Facility Phone: 479 567-5680
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: MS. SHANNON SOUZA
  • NPI Number: 1992421622
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 04D2271630
LAB Type Practitioner Other
Facility Name SHANNAN SOUZA APRN LLC
Street 5150A SR 247
City POTTSVILLE
State AR
ZIP 72858
Phone 479 567-5680
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/4/2024
Certificate Expiration Date 11/3/2026
Facility Type Practitioner Other
Lab Director MS. SHANNON SOUZA

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This page was last updated on: 9/29/2025