06D2192739 CLIA NUMBER - 4 CORNERS CHILDREN'S CLINIC

Laboratory Demographics

  • CLIA Code: 06D2192739
  • Facility Name: 4 CORNERS CHILDREN'S CLINIC
  • Facility Address: 555 RIVERGATE LANE B1-109
    DURANGO, CO
    ZIP 81301
  • Facility Phone: 970 422-8694
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: JESSICA RESNER
  • NPI Number: 1144832981
  • Taxonomy: 363LP0200X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 06D2192739
LAB Type Practitioner Other
Facility Name 4 CORNERS CHILDREN'S CLINIC
Street 555 RIVERGATE LANE B1-109
City DURANGO
State CO
ZIP 81301
Phone 970 422-8694
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/14/2024
Certificate Expiration Date 9/13/2026
Facility Type Practitioner Other
Lab Director JESSICA RESNER

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This page was last updated on: 3/20/2025