13D2296301 CLIA NUMBER - HAZEL HEALTHCARE LLC

Laboratory Demographics

  • CLIA Code: 13D2296301
  • Facility Name: HAZEL HEALTHCARE LLC
  • Facility Address: 2584 N STOKESBERRY PLACE
    MERIDIAN, ID
    ZIP 83646
  • Facility Phone: 208 906-2558
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: EVA BINGHAM
  • NPI Number: 1679355036
  • Taxonomy: 363LP2300X - Nurse Practitioner

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 13D2296301
LAB Type Practitioner Other
Facility Name HAZEL HEALTHCARE LLC
Street 2584 N STOKESBERRY PLACE
City MERIDIAN
State ID
ZIP 83646
Phone 208 906-2558
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/27/2023
Certificate Expiration Date 12/26/2025
Facility Type Practitioner Other
Lab Director EVA BINGHAM

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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