13D2156095 CLIA NUMBER - LAKESIDE MEDICINE

Laboratory Demographics

  • CLIA Code: 13D2156095
  • Facility Name: LAKESIDE MEDICINE
  • Facility Address: 1005 HIGHWAY 2 WEST
    SANDPOINT, ID
    ZIP 83864
  • Facility Phone: 208 290-3302
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: KELLY A. FUHRMAN BC-ARNP
  • NPI Number: 1851873756
  • Taxonomy: 363LP2300X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 13D2156095
LAB Type Practitioner Other
Facility Name LAKESIDE MEDICINE
Street 1005 HIGHWAY 2 WEST
City SANDPOINT
State ID
ZIP 83864
Phone 208 290-3302
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/10/2024
Certificate Expiration Date 10/9/2026
Facility Type Practitioner Other
Lab Director KELLY A. FUHRMAN BC-ARNP

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