07D2059302 CLIA NUMBER - BALANCED WELLNESS PRIMARY CARE, LLC

Laboratory Demographics

  • CLIA Code: 07D2059302
  • Facility Name: BALANCED WELLNESS PRIMARY CARE, LLC
  • Facility Address: 620 NORWICH NEW LONDON TPKE
    UNCASVILLE, CT
    ZIP 06382
  • Facility Phone: 860 892-8012
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: KRISTIN M. MAHAN APRN
  • NPI Number: 1780926774
  • Taxonomy: 363LF0000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 07D2059302
LAB Type Practitioner Other
Facility Name BALANCED WELLNESS PRIMARY CARE, LLC
Street 620 NORWICH NEW LONDON TPKE
City UNCASVILLE
State CT
ZIP 06382
Phone 860 892-8012
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/21/2025
Certificate Expiration Date 5/20/2027
Facility Type Practitioner Other
Lab Director KRISTIN M. MAHAN APRN

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