13D1023169 CLIA NUMBER - NORTHSTAR HEALTHCARE

Laboratory Demographics

CLIA Number: 13D1023169

Facility Name: NORTHSTAR HEALTHCARE

Facility Address:
530 S. HOLMES AVENUE
IDAHO FALLS, ID
ZIP 83401
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Facility Phone Number: 208 529-2352

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1598849051

Taxonomy: 363L00000X - Nurse Practitioner
(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.

CLIA Record

Field Name	Field Value
CLIA Number	13D1023169
LAB Type	Physician Office
Facility Name	NORTHSTAR HEALTHCARE
Street	530 S. HOLMES AVENUE
City	IDAHO FALLS
State	ID
ZIP	83401
Phone	208 529-2352
CertificateType	3
CertificateEffectiveDate	3/9/2024
CertificateExpirationDate	3/8/2026
FacilityType	PPMP

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